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Your PBM contract contains your legal
rights, responsibilities and recourses. Sometimes it serves
as the plan document. It’s a powerful and important
document, yet often the employer only focuses on one section
– pricing. While drug pricing and administrative
fees are important –they can also be secondary if
other aspects of the contract allow or encourage actions
that increase costs by failing to manage utilization. Costs
can increase needlessly and inappropriately from various
common practices such as:
- Dispensing medication in quantities or for time periods
that exceed FDA guidelines
- Dispensing expensive brands when a high quality generic
is available
- Encouraging the use of expensive brand medications through
rebates, which creates a habit that continues even when
the rebate is gone.
Whether you are negotiating a new contract
or in the middle of an existing one, Associates & Wilson
can act as your advocate. As experts in the pharmaceutical
benefits field, we know what little tricks companies play
– and we can examine your contract closely to ensure
that your expectations are met. We often find that the employer
is unaware of provisions in their own contract that empower
them to demand better service from their PBM. With our help,
your contract will mean better value for your money and
better coverage for your employees.
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