Reviewing My PBM Contract

Reviewing My PBM ContractPBMs aim to reduce and control pharmacy benefit costs. This is possible through contract negotiations with suppliers and distributors to reconcile demand and supply. Reduction of benefit costs entails more factors than these aforementioned details.

It is important that you evaluate your PBM contracts in a timely and consistent manner to determine if you are getting the best out of the contract.

Proper and Timely Payments

You may be paying your dues in a timely manner but your PBM may be unintentionally withholding payments. These delays may cost you more than what you are benefiting from. Delayed payments result into penalty fees.

Examine your bills to see if there are fees that are not attributable to your fault. Be vigilant in examining these bills and talk to your manager for similar concerns.


Overpayments may also be costing you a lot. These overpayments may be the result of wrong calculations, wrong account information, wrong orders, rebates on medicines that had a price rollback, or a returned item that you did not use.

One way to effectively control pharmacy benefit costs is to define and standardize the dues and claims that you have, Crystal Clear RX suggests. This will help determine which claims are for reimbursements and which items are for late payments. Request this data and have a PBM consultant look at the records. Once tallied, you will be able to see if you can get reimbursements for the contract.

Options for Generic Drugs

Ask for generic drug options. Your PBM may be signing you up for branded medicines without asking if you are fine with generic options. Generic drugs are cheaper and are more accessible. You will be surprised at how much you can save by choosing change.


Disclosure of interests is important in any commercial contract. A PBM is essentially still a commercial contract. Ask for the disclosure of your PBMs interests to see if there are any conflicts or if they have beneficial tie-ins with companies that aren’t helpful to your cause.

Autonomy of Contracts

You may choose to shorten the contract if you find that it is no longer beneficial for you. Make it a habit to review the contract and the activities of your PBM to see if your best interests are still being preserved.

Review your bills and your contract to see if you are paying for a service that fully benefits you. The aim of enlisting a PBM is to save money and still get the best medicine available. Be vigilant in examining your contract and consult with a professional to determine the best course of action.