Drafting Pharmacy Benefit Manager Contracts: Controlling Costs, Avoiding Hidden Fees

Prescription drug expenses have increased more than any other healthcare category over the past 10 years. PBMs can help employers with self-funded plans control prescription costs, but PBM contracts must be carefully negotiated and drafted to protect the plan sponsor’s—rather than the PBM’s—interests.

Counsel must thoroughly understand the complexities of prescription drug pricing and PBM contracting to control costs, avoid hidden fees, and maximize prescription drug benefit performance. They must also ensure that prescription drug benefits comply with ERISA and ACA requirements.

Listen as our authoritative panel offers strategies for negotiating and drafting PBM contracts. The panel will discuss how to maximize prescription coverage savings, draft agreements that guarantee transparency and plan sponsor oversight, and avoid hidden fees.

1. Overview of PBM contracting
2. Selecting PBMs
3. Negotiating agreements
4. Pricing and fees
5. Monitoring PBMs

The panel will review these and other key issues:

• Ensuring flexibility to remain nimble in a rapidly changing marketplace
• Avoiding drafting pitfalls that increase prescription benefit costs
• Developing effective RFPs to compare and select PBMs
• Conducting an audit of a PBM contract and benefit plan