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Contracting with PBMs: Critical High-Value Issues to Consider
Wiley Rein LLP 
June 14, 2024 "[M]any issues of 'high value' to a health plan (both operationally and financially) are either not addressed in the PBM's template contract, or are addressed in a manner that fails to adequately serve the health plan's functional, regulatory, or competitive needs.... ... [1] Your PBM as your competitor ... [2] Segmenting your pharmacy program (modular contracting) ... [3] Defined terms ... [4] Financial terms." |
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