PBM CONTRACT & CLAIMS AUDITS
Your PBM wrote the contract.
We read it back to you.
Independent pharmacy-benefit audits for self-funded employers. We review hundreds of PBM contracts a year and surface the money hiding in the fine print.
PRICING GUARANTEE
AWP discount: guaranteed in aggregate
Dispensing fee: $[undefined per channel]
Rebate share: "manufacturer revenue"
Audit rights: 90-day window, 1x/yr
Specialty: routed to PBM-owned pharmacy
← spread lives here, ask for per-channel
PBM SERVICES AGREEMENT · §4.2
Contributor to Wendell Potter's HEALTH CARE un-covered · heard on Honest HR, a SHRM podcast · 1,200+ read The Pharmacy Benefits Briefing
$78.7M
savings contracted for clients in 2025
203
Self-funded plans served in 2025
100s
PBM contracts reviewed a year
5
Revenue streams we audit
FREE PLAN SPONSOR TOOLKITS
The frameworks we use internally. Yours, free.
Printable audit worksheets and decision tools, sent to your inbox. Start with the three foundational frameworks, or browse all 29.
PLAIN ANSWERS
The questions plan sponsors actually ask us.
Written answers to the questions that come up in every pharmacy benefits consulting engagement. No form, no gate.
FROM BENEFIT BLIND SPOTS
Recent articles for plan sponsors
One PBM mechanism decoded every week, plus a free, evergreen Contract Language Library. Read here or on Substack
PROOF
Plan sponsors and brokers trust the read.
ON WORKING WITH PRESCRIPTION BENEFIT SOLUTIONS
"Ginny shared valuable insights and advice that I would otherwise not have had the opportunity to acquire. She was honest, accurate, and effective and I believe that she and her team would be an invaluable asset to any self-funded plan looking to understand and leverage their current contract/vendor."
-Benefits leader, self-funded employer, 8,000+ employees
Read by a pharmacist, not a spreadsheet
Prescription Benefit Solutions is led by Ginny Crisp, PharmD, a clinical pharmacist who reviews hundreds of PBM contracts a year for self-funded employers, with a team of pharmacists and analysts across four states.
QUESTIONS PLAN SPONSORS ASK
The short answers
What is a PBM contract audit?
An independent, line-by-line review of your PBM's Services Agreement. It decodes the definitions, checks pricing, rebate, audit-rights, and termination language, and surfaces the clauses quietly costing the plan, with the redlines to fix them.
Can we cut pharmacy spend without disrupting members?
Usually, yes. Most savings come from contract and claims structure, not member-facing changes. We find levers like channel pricing, rebate definitions, and specialty routing that are invisible to employees, so no switched drugs or angry calls.
What is spread pricing?
When a PBM charges the plan more for a drug than it pays the pharmacy and keeps the difference. It often hides inside aggregate pricing guarantees that aren't broken out per channel, which is why a per-channel audit surfaces it.
Do you work with our broker or replace them?
We work behind brokers, never around them. Prescription Benefit Solutions is the independent pharmacy audit bench a broker brings in for their clients; the broker stays the relationship owner the whole way.
How do we get started?
Start with a free 15-minute exposure read: the two or three places your PBM contract is most likely costing you, in plain English. Email team@rxbs.org or grab a free toolkit below.