Negotiation & Advocacy

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PBM Negotiator

Strategic PBM Negotiation for Enhanced Value and Compliance

When it comes to Pharmacy Benefit Manager (PBM) agreements, plan sponsors need a strong advocate to ensure their interests are protected, prioritized, and fully represented. At PBM NEGOTIATOR™, our Negotiation & Advocacy service is designed to empower plan sponsors by securing more favorable contract terms that align with regulatory mandates, financial objectives, and fiduciary obligations. Our team of experienced legal professionals leads PBM negotiations with a deep understanding of pricing structures, rebate policies, and regulatory compliance, ensuring that your agreements deliver maximum financial value and long-term transparency.

Why Negotiation Matters

In today’s rapidly evolving PBM landscape, outdated or non-transparent contracts can lead to excessive drug costs, misaligned rebate structures, and heightened fiduciary risks. Renegotiating PBM agreements is a critical strategy for plan sponsors to control spending, improve service levels, and ensure compliance with federal and state transparency laws. Our Negotiation & Advocacy service focuses on:

Revising Cost Structures: We advocate for contract terms that eliminate hidden fees, enforce full rebate pass-throughs, and remove unnecessary pricing markups that drive up costs.
Securing Transparency and Accountability: Our team ensures that your PBM agreements comply with evolving regulatory requirements, incorporating clear, enforceable transparency provisions that align with new federal and state-level PBM reform laws.
Enhancing Service Level Agreements (SLAs): We negotiate for improved SLAs that hold PBMs accountable for pricing accuracy, claims processing efficiency, and customer service performance, ensuring better outcomes for plan participants.

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Years of Experience

Our collective experience delivers consistent results.

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Cases

Relevant matters and negotiations, prepared for all the possibilities.

Our Proven Approach to Advocacy

PBM NEGOTIATOR™’s advocacy is built on strategic expertise and proactive representation. Our team collaborates closely with plan sponsors to understand their specific challenges and financial objectives, developing a custom negotiation strategy that aligns with their goals. Our process includes:

Comprehensive Pre-Negotiation Analysis: We conduct an in-depth review of current PBM agreements to identify non-transparent pricing, hidden fees, and rebate structures that can be optimized for cost savings and compliance.
Tailored Negotiation Strategy: Our legal experts craft a targeted negotiation plan that leverages legislative mandates, regulatory updates, and market insights to secure stronger financial and contractual terms.
Direct Representation: We represent plan sponsors in PBM contract discussions, ensuring that proposed contract modifications are clearly communicated, justified, and effectively advocated for.

Delivering Meaningful Outcomes

Our Negotiation & Advocacy service has consistently delivered significant financial and compliance improvements for plan sponsors. For example, we assisted a large employer-sponsored health plan in renegotiating their PBM contract to eliminate spread pricing and secure full rebate pass-throughs, resulting in millions in cost savings. The revised contract terms not only enhanced transparency but also ensured compliance with evolving federal and state PBM regulations, strengthening the organization’s fiduciary protections.

Benefits of Partnering with PBM Negotiator

When you choose PBM NEGOTIATOR™ for your PBM contract negotiations, you gain access to a team that prioritizes your financial and fiduciary interests. Our clients benefit from:

Maximized Cost Efficiency: Our negotiation efforts eliminate unnecessary costs, optimize rebate pass-throughs, and enforce competitive pricing structures, delivering immediate and long-term financial benefits.
Stronger Fiduciary Protection: We ensure that your PBM agreements align with the highest fiduciary standards, mitigating risks associated with opaque pricing practices and regulatory non-compliance.
Improved Plan Participant Experience: Enhanced service level agreements (SLAs) and transparent contract terms contribute to a seamless and reliable pharmacy benefits experience, increasing trust and satisfaction among plan members.

Experience the PBM NEGOTIATOR™ Advantage

Negotiating PBM agreements isn’t just about cutting costs—it’s about driving value, ensuring compliance, and protecting your fiduciary responsibilities. At PBM NEGOTIATOR™, our comprehensive Negotiation & Advocacy service is designed to deliver these results. We combine legal expertise, strategic insight, and a client-first approach to help plan sponsors secure the most advantageous contract terms possible.

Take control of your PBM agreements with the confidence that comes from having a dedicated advocate by your side. Contact PBM NEGOTIATOR™ today to learn more about how our Negotiation & Advocacy service can create value and savings for your organization.

Strategic Contract Analysis

Legislative Compliance