Pharmacy Benefit Auditors

Understanding the terms of a Pharmacy Benefit Manager (PBM) contract is extremely difficult for even the most experienced consultants and attorneys. ‘Transparent’ and ‘full pass through’ contracts have removed some of the vagueness, but ambiguity still remains.  Traditional PBM contracts that allow PBMs to retain spread (the difference between the Client paid amount and the price paid to the pharmacy), constitute the majority of the current agreements, and are most difficult to decipher.

The purpose of the contract evaluation is to identify the key components of a well designed PBM agreement and to provide guidance to ensure that any signed agreement includes contractual language that works to the benefit of the Client.  In the contract review certain areas will be identified where the language should be addressed with the PBA team ensuring that the client fully understands all aspects of the agreement before it is signed.  

CONTRACT REVIEW