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PBM Pricing: Do Diligence! (PDF)
Chelko Consulting GroupLink to more items from this source
Nov. 30, 2015
"The standard contract typically allows the PBM discretionary authority to choose and change pricing references, which drugs are on the formulary list and their tier placement, all of which impact your plan's cost. The task is ... to know the cost implications of the contract provisions that favor the PBM.... Plan sponsors should ask if the PBM is using the same [Maximum Allowable Cost (MAC)] list with the plan sponsor as it does with its network of pharmacies, and if the PBM uses the same pricing in retail and mail service. Ask for a copy of the MAC pricing list. Plan sponsors should also insist that the MAC list the PBM provides in the RFP process is the one it actually uses once the contract is signed."

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