Prescription Drug Benefit RFP Support
The traditional vendor search for PBM services consists of creating a request for proposal (“RFP”) and having a broker, consultant or plan sponsor solicit responses from 3 to 5 PBMs (while most plans think in terms of the “Big 3” PBM’s, there are actually approximately 60 PBM’s to consider). This typical process reviews the responses, scores the proposals (based on answers to almost standardized types of RFP questions) and then spreadsheets the pricing including rebate guarantees. This results in the selection of a winner, or perhaps two finalists that can then make a final presentation in order to secure the account. Adding insult to injury occurs when, after going through this process and identifying a new vendor, the plan sponsor is unprepared to identify the many contractual provisions that should be addressed when reviewing the “standard industry contract language.” When challenged during this phase, many PBMs will typically respond that their pricing was developed based on this standard contract language and adjustments that altered the language would require adjustments to their price. The bottom line for most sponsors is an extended and drawn-out review process that may or may not yield any meaningful improvement in their PBM arrangement.
At WBC, our approach eliminates this frustration and ineffectiveness for our clients. We begin with creating a customized RFP that reflects the concerns and areas of importance to the client. The RFP includes contract language requirements in order to have the PBM submit pricing and terms that they will be have to honor and eliminates the need for post-award negotiations. The respondents will also be asked to re-price a claims file as a basis for analyzing their pricing terms when applied to the clients actual utilization. Additionally, we ask the bidders to price a sample of 100 prescriptions identified by eleven-digit National Drug Code (“NDC”) and assumed filled on a specific date
Stated discounts and guaranteed rebates do not provide enough information to make an accurate selection regarding a vendor proposal review. Drug mix (the specific brand name drug or generic drug filled) is one of the leading drivers in managing a plan sponsor’s drug spend. Our procurement process and re-pricing analysis incorporates each bidders drug mix into the equation as well as comparisons of ingredient cost pricing references. All AWP’s are not the same!
WBC incorporates proprietary analytics into our procurement analysis. This methodology will:
- Gather both bidder pricing and sponsor population-specific drug interchange capabilities;
- Re-price a 12-month experience period of claims assuming a range of drug interchange success;
- Project savings and employee disruption (drug interchange) metrics into future contract years; and
- Collect and value the comprehensive, dollar-for-dollar performance guarantees that cover both pricing and drug mix.