You Found a Better Deal. Now Read Your Contract. Why 86% of PBM Contracts Won't Let You Act On It Executive Brief Your specialty pharmacy spend is up 30% year over year. An advisor walks you through a program that could cut several hundred thousand dollars off your specialty drug costs in the first year. The clinical model is sound. The savings are real. The references check out. You want to move forward. Now pull your PBM contract. Find the section on exclusivity and vendor rights. Read it...
10 days ago • 4 min read
Zero Out of Thirty What Contract Data Reveals About Audit Rights Executive Brief Pull your PBM contract. Find the audit rights section. Read it carefully. Here's what you almost certainly will notice: the language looks reasonable. It mentions audits. It references procedures. It allows for inspection. Nothing jumps off the page. Now consider this. Across 30 active PBM contracts in the Contract X-Ray database not one scores Good or above on audit rights. Not one. Not templates, not proposals,...
17 days ago • 4 min read
You Can't Negotiate What You Can't Compare What Employers Learn When They Pool Contract Data Executive Brief Most employers negotiate their PBM contract blind. No benchmark. No reference point. Just whatever the PBM puts in front of them, usually positioned as 'standard language.' PBMs work hard to keep it that way. It's one thing to protect pricing. But it's another to make your contract unshareable and uncomparable. In contrast, government contracts are public documents. Cities, counties,...
24 days ago • 7 min read
Your Contract Is the Foundation Your Benefits Are Built On It Executive Brief Most employers signed whatever contract was put in front of them. They don't know what good looks like because no one ever gave them a benchmark. PBMs don't make comparisons easy. The PBM contract is the foundation your benefits stand on. What it allows, your plan can do. What it forbids, your people live with. Everything downstream, whether costs, formulary, or friction at the pharmacy counter, sits on top of that...
about 1 month ago • 5 min read
Your Experience Is Evidence. Use It. What You’ve Lived As A Fiduciary Matters Executive Brief The DOL comment period closes April 15. What you’ve lived as a fiduciary matters more than any policy argument. Here’s why and how to put it on the record in 15 minutes. The Department of Labor is not running a poll. It’s building an administrative record. That distinction matters. A poll counts votes. An administrative record collects documented experience, legal analysis, and specific evidence...
about 1 month ago • 5 min read
DOL Just Wrote The Safe Harbor Argument You Have Ten Days To Help Put It On The Record. Executive Brief A safe harbor is one of the most valuable things a fiduciary can have. It’s a legal provision that says: if you do X, you’re presumed to have met your duty of prudence. You don’t have to prove everything went right. The burden shifts. That protection is worth a great deal when the lawsuits come. The DOL’s proposed PBM fee disclosure rule includes a “reactive” safe harbor. It protects...
about 2 months ago • 6 min read
April Fools? Not If You Read the Fine Print. The Pranks PBMs Play And How to See Through Them Executive Brief April Fools Day traces back to 16th century France. When the calendar shifted and the new year moved from late March to January 1, people who missed the memo and kept celebrating in spring were mocked as April Fools. The tradition stuck: play a prank on someone who doesn't see it coming. PBM contracts work the same way. They're full of provisions that sneak up on you. Written to...
about 2 months ago • 5 min read
Found a Better Deal? Your Contract Says No. Why Your PBM Has No Obligation to Optimize. And Penalizes You for Trying. Executive Brief Here’s a sentence from an actual PBM contract: “Any agreement or arrangement entered into by Client, directly or indirectly, will invalidate Client’s ability to obtain Rebates.” The employer found a better deal. The PBM’s response: void all rebates. Most employers assume their PBM is actively looking for the lowest-cost drug option in each situation. That’s...
about 2 months ago • 5 min read
The Rebate Trap Your Money. Their Leverage. Executive Brief Here's a scenario playing out in conference rooms across the country right now. An employer discovers their PBM is underperforming. Costs are rising. Transparency is lacking. The fiduciary committee agrees: it's time to explore other options. Then someone asks the obvious question: "What happens to our rebates if we leave?" The answer stops the conversation. The contract says rebates are forfeited upon early termination. Money the...
2 months ago • 7 min read