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Many health plans and large employers fail to write PBM contracts that ensure they receive every dollar that is due to them. In fact, most PBM pacts contain flaws, such as ambiguously defined pricing terms and unenforceable pricing guarantees, which allow PBMs to retain dollars that Rx payers could rightly claim as their own.

To avoid this, health plans and other large Rx payers must take advantage of their leverage during the request for proposal (RFP) process to extract airtight contracts that include “real” pass-through pricing and enforceable financial and performance guarantees. For their part, PBMs that offer transparent business models are touting their approach to clients who want to know exactly where their pharmacy dollars are going.

An experienced PBM consultant and an executive from the PBM industry engage in a lively discussion about the RFP process, PBM contracts, and the crucial strategies Rx payers should employ to save millions of dollars. Specific questions that will be discussed include:

• What key questions should Rx payers ask themselves before preparing to send out an RFP to PBMs?
• How can health plans and self-funded groups use the RFP process to drive down pharmacy spending?
• How are PBMs responding to today’s RFPs, and what services can they provide that make them stand out?
• What PBM contract loopholes should you be on the lookout for?
• How can you ensure a prospective PBM is offering true transparency?
• What types of contract guarantees are PBMs willing to give clients?

Speakers

LINDA CAHN is president of Pharmacy Benefit Consultants, a consulting firm based in Morristown, N.J. In 1997, Ms. Cahn initiated the first class-action litigation against two of the largest PBMs. Since then, Ms. Cahn has been deeply involved in consulting and litigating on drug benefit and pricing issues. As a result, she has reviewed hundreds of confidential contracts between PBMs and their clients, scores of RFPs, and hundreds of thousands of confidential internal PBM documents revealing how PBMs create profit margins and thereby increase their clients’ costs. She also has worked with executives and trustees of FORTUNE 50 and smaller employers, insurance companies, unions, government representatives and coalition executives to review their PBM contracts, analyze why their drug costs are continuously increasing, conduct RFPs, and negotiate and draft new contracts to improve their drug benefits and decrease their costs.

DAN COADY is director of pharmacy benefit administration (PBA) strategies at HealthTrans LLC, a large national PBM based in Greenwood Village, Colo. In this role, Mr. Coady is responsible for being the “one-stop-shop” for all information on PBA products and services at HealthTrans, including roles in proposal development, pricing, analytics, consulting and product development. With more than 13 years of experience in the employee benefits and insurance industries, Mr. Coady has significant expertise in RFP support as well as pharmaceutical pricing, and he has consulted for payers with millions of eligible beneficiaries. Prior to joining HealthTrans, Mr. Coady was principal proposal analyst at UnitedHealth Group (which acquired PacifiCare Health Systems/Prescription Solutions). He also has served in a variety of proposal and strategic development roles for a business process outsourcing firm as well as third-party administrator in the health care sector. Mr. Coady began his career at PricewaterhouseCoopers LLP (formerly Coopers and Lybrand) in benefits consulting and is a graduate of the University of California at Los Angeles (UCLA) with a B.A. in economics. 

Moderator: Neal Learner, managing editor of AIS’s Drug Benefit News

Designed Especially For

Business development and marketing directors, financial managers, pharmacy directors, medical officers, clinical services directors, product developers, consultants and contracting executives at:

• Health plans
• Large employers
• Pharmaceutical manufacturers
• Public employee retirement plans
• PBMs
• Pharmacy retailers
• Pharmacy benefit consultants

Written Materials