All offerings culminate in a non-biased Executive Summary format that can be shared with clients.

Bid information and financial terms specific to individual PBMs may be shared with clients but would otherwise be proprietary and confidential, not to be shared with incumbents or other bidders.

 

Contract Review

• Financial terms vs. market averages / benchmarks

• Contract language vs. best in class options

• Gaps / errors of omission

• Areas for improvement

• Full written summary of findings

• Actionable next steps

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Benefit Design Review

• Benefit design recommendations (need all current SPDs)

• Top Drug lists and plan exclusions are helpful

• Description of a company’s culture and preferences is helpful

• Deliverable includes a pharmacy benefit assessment and limited medical assessment, especially areas impacted by Rx

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Incumbent Renewal

• Contract review (includes all deliverables above)

• Incumbent as the only bidder

• Will assist with negotiations to improve the current contract for the next benefit year

• New contract review prior to sign off

• Ongoing contract monitoring

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Competitive Renewal (Does not include BAFOs or Finalist meetings)

• Contract review (includes all deliverables above)

• Benefit design review if SPDs are provided (see above)

• High level clinical review

• Will include evaluation of incumbent plus 4 bidders

• Consideration of add on / bolt on options if information is provided

• If incumbent stays, will assist with negotiations to improve terms

• If a new PBM partner is selected, will provide implementation support

• New contract review prior to sign off

• Ongoing contract monitoring

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Full Two-Phase RFP (Includes BAFOs and Finalist Meetings)

• Contract review

• Benefit design review if SPDs are provided (see above)

• Deeper clinical review and options for management

• Will include evaluation of incumbent plus up to 6 additional bidders

• Consideration of add on / bolt on options if information is provided

• Reverse Auction, finalist bid process

• Meetings with 2 finalists

• If incumbent stays, will assist with negotiations to improve terms

• If a new PBM partner is selected, will provide implementation support

• New contract review prior to sign off

• Ongoing contract monitoring

 

Clinical Options (choose all that apply)

• Evaluation of bolt-on vendors including, but not limited to: 

  • specialty carve out options 

  • PAP/MAP vendors (i.e., SaveOnSP, PrudentRx, Archimedes) 

  • disease management companies (i.e., Virta Health, Omada, Livongo) 

  • concierge services (i.e., Quantum) 

  • chronic care management companies (i.e., Tria Health) 

  • pharmacogenomics labs / services (i.e., RxGenomix, OneOme)

• Formulary disruption clinical impact analysis (disruption must be provided by PBM)

• Fully-Insured data review

  • Top Drugs

  • High Cost Claimants

  • Specialty Reporting

• Branded claims review and “counter-detailing”

• Specialty review

• Mark Cuban Cost Plus Pharmacy analysis

• Case reviews - drug and patient chart notes

• Educational sessions & materials for brokers / consultants

• Educational sessions & materials for employers / members

• J-code assessment and SOC (site of care) options

• Discount card that can be offered for non-covered drugs and/or part time employees

 

In Development

• Adherence - Mental Health

• Adherence - Diabetes

• Adherence - Cardiovascular 

• Med/Rx gaps in care analysis and ideas for member / provider / plan action steps

• PGx at POS

• Clinical newsletter quarterly based on P&T attendance & market happenings - member and group-friendly