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Plan Sponsor Toolkit Library

Free printable audit frameworks and decision tools PBS uses across 100s of PBM contract reviews annually

Start Here · Foundational Frameworks

New to this? Begin with these three. They frame the whole review.

Contract Review Readiness Checklist, first page of the free PBS plan sponsor framework: eight documents to pull and fifteen audits to run before a PBM contract review.

Contract Review Readiness Checklist

The 8 documents to pull before you open your PBM contract.

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Optimize vs Go-to-Market Decision Framework, page one of the PBS plan sponsor framework scoring whether to renegotiate a PBM or run an RFP.

Optimize Existing vs Go-to-Market Decision Framework

Decide whether to renegotiate your current PBM or run an RFP.

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Pharmacy Benefit Review Framework, first page of the PBS plan sponsor twice-yearly review across six categories and twenty audit items.

Pharmacy Benefit Review Framework

The twice-yearly structure of a plan-sponsor pharmacy benefit review.

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Transparency & Industry Education

See where your plan's dollars actually go before they reach the pharmacy counter.

Rebate Report Audit Worksheet, page one of the PBS plan sponsor worksheet for reading what a PBM rebate report leaves out.

Rebate Report Audit Worksheet

Read what your PBM's rebate report doesn't say out loud.

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Channel Pricing Audit Worksheet, a 2-page PBS plan sponsor toolkit for auditing per-channel net cost across retail, mail, and specialty

Channel Pricing Audit Worksheet

Three passes that surface spread across retail, mail, and specialty.

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PBM Compensation Audit Worksheet, page one of the PBS plan sponsor worksheet mapping the five revenue streams a PBM earns from your plan.

PBM Compensation Audit Worksheet

Map all five revenue streams flowing from your plan to your PBM.

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PBM Disclosure Audit Worksheet, page one of the PBS plan sponsor worksheet on what a PBM must disclose versus what it actually shares.

PBM Disclosure Audit Worksheet

What the PBM must disclose versus what it actually does.

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PBM Contract Insights

The contract language and clauses that decide what you can audit, change, and recover.

Quarterly Reporting Checklist, first page of the PBS plan sponsor checklist of 15 line items a PBM quarterly report should contain.

Quarterly Reporting Checklist

15 lines to read first in the report your PBM sends each quarter.

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Generic Effective Rate Audit Worksheet, first page of the PBS plan sponsor worksheet testing PBM GER guarantees against actuals.

Generic Effective Rate Audit Worksheet

Test your guaranteed effective rate against the actuals.

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Definition Variance Audit, first page of the PBS plan sponsor audit of costly definition variances in a PBM contract.

Definition Variance Audit

Where the contract's definitions quietly cost you.

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Mid-Year Contract Amendment Letter Template, first page of the PBS paste-ready redline letter for amending a PBM contract mid-cycle.

Mid-Year Contract Amendment Letter Template

Paste-ready redline letter to send your PBM mid-cycle.

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Mid-Year Performance Guarantee Audit, first page of the PBS plan sponsor audit checking PBM performance guarantees at mid-year.

Mid-Year Performance Guarantee Audit

Check performance guarantees at the mid-year mark.

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RFP Scoring Methodology Audit, page one of the PBS plan sponsor worksheet for scoring PBM RFP responses on what matters.

RFP Scoring Methodology Audit

Score PBM RFP responses on what actually matters.

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Termination Clause Audit, page one of the PBS plan sponsor audit of the PBM contract termination clauses that govern exit.

Termination Clause Audit

The clauses that decide whether you can actually leave.

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Clinical Pharmacy Perspectives

Budget for and manage the high-cost drug trends heading toward your plan.

Drug Pipeline Watch List 2026-2027, first page of the PBS plan sponsor guide to five high-cost drug categories to budget for.

Drug Pipeline Watch List 2026-2027

Five drug categories to budget for in 2026-2027.

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Member Transition Audit, page one of the PBS plan sponsor audit for protecting members through a PBM or formulary switch.

Member Transition Audit

Protect members through a PBM or formulary switch.

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Biosimilar Readiness Assessment, page one of the PBS plan sponsor six-factor check for biosimilar conversion readiness.

Biosimilar Readiness Assessment

A six-factor readiness check for biosimilar conversion.

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Specialty Routing Audit Worksheet, first page of the PBS plan sponsor worksheet on where specialty scripts route and why it costs more.

Specialty Routing Audit Worksheet

Where your specialty scripts get routed, and why it costs more.

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Step Therapy Override Audit, first page of the PBS plan sponsor audit of the PBM step-therapy override pathway.

Step Therapy Override Audit

Audit your step-therapy override pathway for friction.

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Cost Containment Strategies

Find pharmacy spend hiding in claims, networks, and programs you already pay for.

PA ROI Audit Scorecard, first page of the free PBS plan sponsor scorecard for auditing prior-authorization return on investment.

PA ROI Audit Scorecard

A five-metric scorecard to audit your prior-authorization ROI.

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Pharmacy Network Configuration Audit, page one of the PBS plan sponsor audit of pharmacy network steering and hidden margin.

Pharmacy Network Configuration Audit

Check the pharmacy network for steered margin.

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Copay Card Financial Impact Calculator, first page of the PBS plan sponsor model for copay card and accumulator financial impact.

Copay Card Financial Impact Calculator

A five-step model for copay card and accumulator impact.

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Coordination of Benefits Audit Worksheet, first page of the PBS plan sponsor worksheet for recovering pharmacy spend in COB gaps.

Coordination of Benefits Audit Worksheet

Recover spend hiding in coordination-of-benefits gaps.

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Mid-Year Claims Red Flag Checklist, first page of the PBS plan sponsor checklist of five pharmacy claim patterns to catch before renewal.

Mid-Year Claims Red Flag Checklist

Five claim patterns to catch before they compound into renewal.

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Self-Funded Employer Guidance

Decision frameworks and fiduciary checks for the plan sponsor running the benefit.

Carve-Out Decision Scorecard, page one of the PBS plan sponsor tool weighing pharmacy carve-in versus carve-out across ten factors.

Carve-Out Decision Scorecard

Ten factors that decide carve-in versus carve-out.

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Fiduciary Compliance Audit, first page of the PBS plan sponsor audit testing the health plan against its ERISA fiduciary duties.

Fiduciary Compliance Audit

Test the plan against its ERISA fiduciary duties.

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Fiduciary Documentation Checklist, page one of the PBS plan sponsor checklist of five documentation categories that protect ERISA fiduciaries.

Fiduciary Documentation Checklist

Five documentation categories that protect the plan fiduciary.

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First Renewal Meeting Pre-Meeting Checklist, page one of the PBS plan sponsor checklist to settle before a PBM renewal meeting.

First Renewal Meeting Pre-Meeting Checklist

What to settle before you walk into the renewal meeting.

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H1 Renewal Readiness Scorecard, page one of the PBS plan sponsor scorecard of five mid-year metrics for PBM renewal readiness.

H1 Renewal Readiness Scorecard

Five mid-year metrics plus a renewal-readiness score.

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