Read: Reference-based pricing: where do carriers go from here? pharmacy benefit manager

  • Do they have a contract specific to their pharmacy benefit?
  • Does their contract clearly list out the discounts/fees/rebates that are applied to your claims utilization?
  • Does their contract clearly define under what circumstances those discounts/fees/rebates are applied to their claims?
  • Does their contract clearly state what detailed information they will have access to relative to their claims utilization and experience?
  • Does their contract contain audit rights that allow them to validate that their carrier or PBM is compliant with their financial obligations under the contract?

Conclusion what your clients pay for pharmacy benefits

Cory Easton is a Partner at Confidio, a technology enabled pharmacy benefit consulting firm serving millions of members nationally. For more information please visit: www.confidio.com or to reach the author, please email him: [email protected] .

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