RFP Questions You Should be Asking

by | May 24, 2022 | Blog Post, Contract Management

When evaluating a PBM contract at renewal or mid-term market check, brokers and plan sponsors should be asking questions. Questions that lead to a thorough understanding of their current PBM contract so they can negotiate better, plan-centric programs. Beyond basic evaluation of traditional vs. pass-through structures, other areas such as plan priorities, rebates, and formulary management should also be assessed to simplify benchmarking.

Question plan priorities

  • How does the current model prioritize best plan value and best patient outcomes?

  • How is the existing structure providing the most benefit for the plan and participants?

  • Are claims repriced and evaluated equally amongst potential candidates?

  • Are the candidates looking to build a program in the best interest of the plan or to boost their bottom line?

Question rebates

  • How are rebates being managed by the current PBM?

  • How are rebate reports provided?

  • Do reports include drug-level price transparency? Why or why not?

  • What tools are utilized as a part of the rebate validation process?

Question formulary management

  • Does the formulary maximize rebates, lowest cost, or clinical outcomes? Is this in line with plan goals?

  • What clinical programs support the formulary in achieving best patient outcomes?

  • What misaligned financial incentives are driving formulary management and/or clinical decisions?

  • What high-dollar medications are being approved for the benefit of revenue and rebates, not the plan?

Once answered, these questions guide the RFP or market review processes. A more detailed understanding of how the current program aligns with plan goals allows plan sponsors to demand more transparency from their current PBM and make more informed decisions when comparing other contracts.

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If you are starting the RFP or market check process and are unsure of the answers to any of the questions above, PCM can help. Our Market Check tool allows brokers and plan sponsors to dynamically compare current contract and effective rates to market rates, all in one place. Compare cost share, admin fees, discount percentages, rebates, and utilization across multiple PBMs. Click here to see what Market Check can do for you.

Updated: May 25, 2022