5 Must-ask Questions Before the PBM RFP Process

Read the full article by AlignRx COO Greg Sanderson on Employee Benefit News. 

While it may seem early to be thinking about 2023, summer is prime time for issuing pharmacy benefit manager RFPs. In a healthcare environment where an annual cost increase is expected both by employer groups and employees, finding the right PBM relationship can reverse this troubling trend and actually lower overall healthcare spend.  

But these contracts are anything but simple, and what you see may not be what you get. There are multiple layers and even hidden languages to sift through. That’s right, some PBMs have different meanings for words as seemingly straightforward as “generic” or “rebate.”  

PBM contracts can, and should, be customized to ensure your employer clients are receiving the best value out of their PBM. During the RFP process it is not unusual for a questionnaire to contain more than 150 questions that the PBM must complete in order to accurately evaluate the offer being proposed. While daunting, employer groups often uncover savings of 20% or more when going through this process. Here are key questions to guide the search for the optimal PBM: 

  1. Is this a transparent or traditional PBM pricing arrangement?
  2. What are the discount and rebate guarantees being offered?
  3. What cost-containment programs are available through the PBM?
  4. How does the PBM define key financial terms?
  5. What will account management support look like?

Learn more about each question in the full article on Employee Benefit News.