Analyze & Optimize Your PBM Contract

The PBM contract is the cornerstone of your Plan’s prescription coverage. It's the single most important document you’ll execute when it comes to managing drug costs and services.

Unfortunately, most PBM contracts are riddled with loopholes and poorly structured terms that fail to protect your interests or control costs. That’s why it’s crucial to reassess and reframe your contract to better serve your needs.

When you compare the contract terms that Green Spring Insurance secures for clients against the typical terms in most contracts, you’ll see the difference. Here are some key areas where we provide superior terms:

Pass-Through Pricing

  • GSI Clients: Pass-through pricing for every drug dispensed, ensuring full transparency on costs.

  • Typical PBM Contracts: Pass-through pricing is often only applied to retail drugs, with PBMs keeping undisclosed profit margins on mail and specialty drugs.

Specialty Drug Pricing

GSI Clients: A comprehensive “Minimum Discount Guarantee” for all Specialty Drugs, or an option for a focus on the most frequently used drugs.

Typical PBM Contracts: Limited guarantees for only a small list of drugs, often leaving hundreds of specialty drugs uncontrolled, driving up costs.

Price Control on Every Drug

  • GSI Clients: Full price control over every drug dispensed, preventing surprise cost escalations.

  • Typical PBM Contracts: Guarantees are limited to broad categories, leaving out certain drugs like compounds or specialty medications, allowing PBMs to set arbitrary prices.

Rebates and Financial Benefits

GSI Clients: 100% pass-through of all financial benefits, not just rebates, from any third parties.

Typical PBM Contracts: PBMs retain significant portions of manufacturer rebates and other financial benefits, creating an opaque system that benefits them rather than the Plan.

Guaranteeing Generic Drug Pricing

  • GSI: The ability to monitor newly available generic drugs and negotiate pricing to ensure the lowest costs.

  • Typical PBM Contracts: No mechanism for ensuring that clients benefit from reduced prices once generics hit the market.