At PBM NEGOTIATOR™, we employ a structured oversight process that ensures every aspect of PBM contract management is continuously evaluated for compliance, cost efficiency, and performance accountability. Our experienced team proactively monitors PBM adherence to contractual terms, regulatory requirements, and pricing transparency standards, providing plan sponsors with the insight needed to make informed, strategic decisions. Our oversight service includes:

• Regular Compliance Audits: Periodic reviews of PBM agreements to confirm adherence to state and federal transparency laws, identifying contract terms that require updates.
• Performance Tracking and Reporting: Ongoing monitoring of PBM service level agreements (SLAs) to ensure that pricing accuracy, rebate pass-throughs, and claims processing meet agreed-upon standards.
• Cost Analysis and Adjustments: Evaluation of fees, rebate structures, and drug pricing to uncover hidden costs and identify opportunities for financial optimization and renegotiation.

Client-Focused Oversight for Long-Term Success

At PBM NEGOTIATOR™, our continuous oversight is more than just a service—it’s a commitment to supporting plan sponsors with vigilant contract management and proactive compliance strategies. Our client-first approach ensures that we are always available to:

• Address urgent contract concerns
• Review new legislative developments
• Provide strategic recommendations to adapt PBM agreements to evolving regulatory and market conditions

Delivering Value Through Vigilance 

Continuous oversight provides measurable benefits for plan sponsors. For instance, one of our clients was able to preemptively resolve a compliance issue when our team detected pricing discrepancies in their PBM rebate reports. By identifying the issue early, we facilitated a swift contract adjustment, ensuring compliance while also reducing costs for the client.

Key Benefits of Our Continuous Oversight Service

Partnering with PBM NEGOTIATOR™ for ongoing oversight provides plan sponsors with:

• Regulatory Confidence: Stay fully compliant with evolving state and federal PBM regulations, including pricing transparency mandates and rebate disclosure laws.
• Performance Assurance: Ensure that PBMs uphold all SLAs, providing the pricing integrity, rebate pass-throughs, and claims management accuracy that plan participants depend on.
• Financial Safeguarding: Detect and address cost inefficiencies, ensuring that plan sponsors avoid overcharges and maximize financial value over time.