TIER 1 · PBM CONTRACT REVIEW · READINESS CHECKLIST
Pull Eight Documents. Surface Fifteen Audits.
The Readiness Checklist Before Your PBM Contract Review.
A 2-page printable framework PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
8-document set to pull before the review kickoff
15 per-mechanic audit components mapped (financial, contract, workflow)
Optimize-existing vs go-to-market recommendation with dollar magnitudes
Paste-ready broker email to request what's missing
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
The Decision the Review Produces
Every Contract Review integrates fifteen per-mechanic audits: financial (channel pricing, rebate, PBM compensation, GER/BER), contract clauses (performance guarantee, network, disclosure, termination, definitions), workflow (step therapy, specialty routing, COB, member transition). Each runs standalone in half a day.
PASS 01
Documents to Gather
Pull eight items before the review kickoff: current PBM Services Agreement and amendments, prior contract versions, last four quarterly reports, Plan Document, stop-loss policy, prior RFP/evaluation docs, member disruption logs. Whatever is missing is a finding by itself.
PASS 02
Fifteen Audits Mapped
Every Contract Review integrates fifteen per-mechanic audits: financial (channel pricing, rebate, PBM compensation, GER/BER), contract clauses (performance guarantee, network, disclosure, termination, definitions), workflow (step therapy, specialty routing, COB, member transition). Each runs standalone in half a day.
ACTION PLAN
This Quarter's Action Plan
Pull the document set. Schedule a 60-90 minute kickoff. Make the team available for follow-up questions. Convene the benefits committee to receive the findings and the optimize-vs-go-to-market recommendation. The next 12-18 months continue under twice-yearly Pharmacy Benefit Review cadence.