Whether you need to renew your PBM contract or looking to go to market to evaluate other PBM vendors, audit your existing PBM, or need other support relative to your PBM program contact NPCG first.
As the PBM industry changes, contractual protections become obsolete and create exposure for clients. Many times, items not addressed in ‘silent language’ can be the client’s worst enemy. Our team has the skills and experience to identify these hidden areas in the language to protect the plan from risk.
Employers, Pharmacies, Health Plans, Health Systems
NPCG works closely with our clients in the development and preparation of the Pharmacy Benefit Manager (PBM) request for proposal (RFP). We will formally evaluate vendors and develop a pharmacy benefit RFP specific to the Plan’s needs and distribute to vendors that best align with the Plan’s goals.
We will review and analyze the vendor proposals based on the customized RFP and required criteria. The results of the vendor evaluations will be presented in a comprehensive and formal report of findings document that include both quantitative and qualitative analytics.
NPCG provides assessment, feedback and guidance of your current PBM vendor contract and in matriculating to a novel PBM, the firm will work with you to negotiate the new PBM contract. The contract negotiation includes financial components, rebates, administrative fees, pricing terms, provisions, definitions, performance guarantees and more.
As we monitor the ongoing contract, we will mediate discrepancies over contract issues; recommend whether a contract should be renewed, terminated or modified; as well as update and negotiate contract elements as appropriate throughout the term of the agreement.
A comprehensive PBM audit is an imperative device to truly understand how the prescription drug plan is performing today and how to best manage it for the future. Decreasing costs relative to pharmacy requires widespread knowledge to interpret the ambiguity and complexity in contracts, formularies and plan design.
Enacting a comprehensive PBM audit allow plans to become informed, understanding drug benefit design, evaluating the efficiency of drug utilization, monitoring the performance of their PBM and assessing if the costs charged and services provided were in accordance to the terms of the contract.
Our clinical pharmacy consultants have years of experience operating collaboratively with PBMs, pharmacy administrators, medical directors and others to provide a clinical, consultative process for the prescription drug plan. Our proactive cost containment measures protects clients from inappropriate medication use and wasteful spending.