When reviewing a PBM contract and benefits plan, there are a few areas I always analyze to ensure maximum savings are being achieved for my clients. Areas of concern are formularies, benefits design and specialty/mail pharmacy.
If you’re reading this blog, you’re most likely aware how cumbersome and intricate pharmacy benefit management (PBM) contracts can be. Negotiating these contracts properly takes a deep understanding of PBM business practices and definitions, industry-specific language, and pricing structures.
In 1997, Richard Carlson wrote a great book titled “Don’t Sweat The Small Stuff." Although I agree totally with the premise of that book in the general context of our daily lives, it may not be a good strategy when it comes to pharmacy benefits. Over the next few BLOG posts we will discuss some of these.