Simplan engages an independent consultant to provide feedback on PBM contracts allowing our clients the opportunity to discuss their contract language and terms with the PBM to achieve better Rx cost containment goals.
With pharmacy benefits costing health plans and employers in excess of 20% of total medical spend, closely managing pharmacy programs has never been more important and is a critical component of Simplan prescription benefit best practices.
To this end, our independent consultant performs the following actions:
- Conducts annual claims review to ensure PBM contract adherence in the areas of contracted AWP discounts, dispensing fees, and rebates
- Ensures the most cost effective PBM is in place for each client
- Renegotiates contract terms and pricing as opportunities arise
- Provides insight into PBM trends and programs to ensure clients have the right management techniques in place