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A weekly newsletter of compliance best practices, cost-saving strategies, time-saving tools, and case studies with real world results for employer-sponsored health plan fiduciaries
Plans Negotiate the Price. PBMs Write the Rules. The terms nobody owns decide what the negotiated terms are worth Executive Brief The contracts we review show clear signs of negotiation. Discount guarantees move. Rebate guarantees move. Dispensing fees, administrative fees, and performance guarantees move. Compare a PBMβs contracts across different employers and the pricing grids differ from client to client. But the governance language stays put. Audit scope, data ownership, rebate...
Your Contract Has No Exit Ramp 67 agreements. 27 PBMs. Zero extension clauses. Executive Brief I spent Friday at a conference talking with PBMs. Theyβre still receiving RFPs for January 1 starts. Several said the same thing: to implement on time, they need a signed contract in two weeks. Thatβs a tighter deadline than most plan sponsors think theyβre working against, and the vendors know it better than the buyers do. Hereβs what happens when a sponsor arrives at signature with two weeks of...
6 Weeks To Set The Next 3 Years The 90 Standard. Any size. Any sector. Executive Brief Most January 1 pharmacy contracts get signed in the next six weeks. The term will likely run three years. That's forty-two days of attention governing more than a thousand days of spend. For a 5,000-life employer at roughly $1,200 per member per year, the commitment can easily clear $20 million. The most valuable thing you can do with it takes one sentence and costs nothing. We call it "The 90 Standard."...