PRM RISK ASSESSMENT

Determine Current PBM Risk Factors with Three Simple Assessments

The role of human resources in managing prescription drug benefits has never been more crucial. Recent high-profile lawsuits have underscored the importance of proactive and informed oversight of pharmacy benefits.

ASSESSMENT one

ASSESSMENT one

Compare Your Top Drugs

Is your PBM actually providing your employees with fairly priced medications and optimizing for low out-of-pocket costs? Are they ensuring the lowest net cost for you as the plan sponsor? Complete your own top drug analysis now.

Download Free Worksheet

Top Drug Comparison Worksheet

Download Free Worksheet

Top Drug Comparison Worksheet

Tip

How do I check how much I pay for these medications?

1

Ask your PBM account manager

2

Use your PBM portal

*Warning: Some PBMs charge extra for claims-level reporting

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Our Promise

TIP

How do I check how much I pay for these medications?

How do I check how much I pay for these medications?

1

1

Ask your PBM account manager

Ask your PBM account manager

2

2

Use your PBM portal

Use your PBM portal

*Warning: Some PBMs charge extra for claims-level reporting

ASSESSMENT Two

ASSESSMENT Two

Calculate Your PMPM

What are your per member per month costs including admin fees, ancillary fees, and drug costs? Find out using this simple calculator.

Calculate Your PMPM

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ASSESSMENT Three

Understand Your PBM Evaluation Process and Contract

The current RFP process for PBMs obfuscates real costs by overly focusing on discounts. If you answer “yes” to any of the questions, your evaluation process may be flawed.

Did you pay separately for the RFP process or was it subsidized?

Why does this matter?

Beware of "free" RFP offers from pharmacy consultants. These costs (up to $7 PMPM) are often built into the PBM's spread pricing, leading to higher drug costs. What seems free upfront ultimately increases your pharmacy spend.

Is your PBM involved in financial relationships with brokers or consultants?

Why does this matter?

PBMs that have financial arrangements with brokers or consultants can create conflicts of interest. These hidden payments, often passed onto the client, may lead to higher overall costs and reduced transparency in how your plan is managed.

Were all the top bidders for your PBM contract legacy providers?

Why does this matter?

If your consultant only provided legacy PBM options, there is a conflict of interest. Modern PBMs definitively provide the same level of service at lower overall pharmacy costs. Your RFP process is incomplete without these cost-effective alternatives.

Does your PBM contract include AWP and rebate guarantees?

Why does this matter?

Beware of discount-based contracting. Your discounts may increase every year, and yet your PMPM spend may increase as well. This should not happen, and is a clear indication that your PBM contract is not delivering real cost savings.

Did you pay separately for the RFP process or was it subsidized?

Why does this matter?

Beware of "free" RFP offers from pharmacy consultants. These costs (up to $7 PMPM) are often built into the PBM's spread pricing, leading to higher drug costs. What seems free upfront ultimately increases your pharmacy spend.

Is your PBM involved in financial relationships with brokers or consultants?

Why does this matter?

PBMs that have financial arrangements with brokers or consultants can create conflicts of interest. These hidden payments, often passed onto the client, may lead to higher overall costs and reduced transparency in how your plan is managed.

Were all the top bidders for your PBM contract legacy providers?

Why does this matter?

If your consultant only provided legacy PBM options, there is a conflict of interest. Modern PBMs definitively provide the same level of service at lower overall pharmacy costs. Your RFP process is incomplete without these cost-effective alternatives.

Does your PBM contract include AWP and rebate guarantees?

Why does this matter?

Beware of discount-based contracting. Your discounts may increase every year, and yet your PMPM spend may increase as well. This should not happen, and is a clear indication that your PBM contract is not delivering real cost savings.

Resources

Critical PBM Knowledge

Magnifying glass over a pink background revealing a glowing yellow warning triangle icon

PBM 101

6 Ways Legacy PBMs Put Employers at Risk

Learn how SmithRx transforms pharmacy benefits with real savings and member satisfaction. Our modern, transparent approach delivers higher ROI, eliminates hidden fees, and improves employee health outcomes.

date

Take the Next Steps to Protect Your Team and Organization

Take the Next Steps to Protect Your Team and Organization

Insights and Updates for Plan Sponsors

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PBM 101

What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes

Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.

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Modern PBM

Choosing the Right PBM: How to Evaluate Cost Savings vs Discounts

When it comes to PBM evaluation, explore the importance of choosing a cost-based over discount-based approach to ensure transparency and real savings in prescription medications.

date

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PBM 101

What Does a PBM Do to Reduce Costs?

Concerned about rising drug costs for your self-insured plan? Explore how PBMs negotiate lower prices and implement strategies to save your company money.

date

Insights and Updates for Plan Sponsors

View All Articles

Pharmacy benefits reform concept, government legislative building shown with overpriced medications

PBM 101

What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes

Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.

date

An unbalanced silver justice scale on a wooden surface against a dark chalkboard background

Modern PBM

Choosing the Right PBM: How to Evaluate Cost Savings vs Discounts

When it comes to PBM evaluation, explore the importance of choosing a cost-based over discount-based approach to ensure transparency and real savings in prescription medications.

date

Stack of coins beside a white calculator, notebook and pencil on a purple surface

PBM 101

What Does a PBM Do to Reduce Costs?

Concerned about rising drug costs for your self-insured plan? Explore how PBMs negotiate lower prices and implement strategies to save your company money.

date

Insights and Updates for Plan Sponsors

View All Articles

Pharmacy benefits reform concept, government legislative building shown with overpriced medications

PBM 101

What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes

Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.

date

An unbalanced silver justice scale on a wooden surface against a dark chalkboard background

Modern PBM

Choosing the Right PBM: How to Evaluate Cost Savings vs Discounts

When it comes to PBM evaluation, explore the importance of choosing a cost-based over discount-based approach to ensure transparency and real savings in prescription medications.

date

Stack of coins beside a white calculator, notebook and pencil on a purple surface

PBM 101

What Does a PBM Do to Reduce Costs?

Concerned about rising drug costs for your self-insured plan? Explore how PBMs negotiate lower prices and implement strategies to save your company money.

date