|
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
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...
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...
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...