Direct Contracting PBA

PBA Services – Direct Contracting

As a result of changes in the marketplace and advancement in technology, Direct Contractingalong with the continued dependence on the AWP pricing benchmark, we believe that the momentum has started where more plan sponsors will be considering direct contracting with pharmaceutical manufacturers, wholesalers service providers and pharmacy networks. This new strategy will dramatically alter or reduce the role played by traditional PBMs. The process is referred to as “direct contracting” or “disintermediation” and will change the marketplace dynamics of providing pharmacy benefits.

One option of direct contracting is when a plan sponsor creates a “DIY” alternative and outsources the administrative systems and support functions required to operate as their own PBM.  These outsource vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services. The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsors of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.

Financial benefits are only one element to consider, however, in a review of direct contracting. Additionally, a plan sponsor needs to evaluate the operational components as well as the strategic fit within their organization.

WBC is well-equipped to help you through this evaluation process and ultimately, the installation and operations of a plan sponsors’ pharmacy benefit program. A claims re-pricing and contract analysis will provide the plan sponsor with a preliminary report on whether there is financial opportunity and can quantify the degree of improvement available. Once the scope has been defined, a feasibility analysis will examine all of the elements involved in creating the business case for recommending a change in your pharmacy benefit arrangements. This process includes:

  • Identifying Organizational goals
  • Resource GAP analysis
  • Feasibility of on-site pharmacy
  • Risk analysis
  • Financial modeling with acquisition cost pricing
  • Best Practice benchmarking
  • Resource allocation plan
  • Implementation workplan

Once the report has been created, recommended and accepted by the plan’s senior management, WBC is available to help you with the implementation and execution of an amended pharmacy benefit management plan, including contract negotiations and operations.

Additionally, we also have the complete support framework and infrastructure built to provide all of the services necessary in becoming a PBM. Our service model is known as Mutual Rx, Inc. ( and includes claims adjudication, billing and payments, network contracting, mail order, specialty drugs, rebate contracting, clinical programs, reporting and analytics, call center, and member services.

Being at the forefront of pharmacy benefit management is a hallmark of our organization. Our PBM platform is being enhanced to incorporate blockchain technology that is building a private pharmacy ecosystem to better serve our clients and their members.  We look forward to discussing the needs of your organization and helping you determine whether our services can be the right solution.