TIER 2 · IMPLEMENTATION VERIFICATION · JANUARY 1 GO-LIVE
You Negotiated It. Did Anyone Load It?
Verify the Build Before January 1.
A 2-page printable checklist for confirming your negotiated PBM terms are actually configured in the adjudication system. Free download. Sent to your inbox.
7 pre-go-live checks, each with the red flag that signals a gap
Pricing, formulary, utilization management, accumulators, guarantees
Paste-ready implementation verification request to send your PBM
30/60/90 sequence for the first quarter of the plan year
Get the Worksheet
PDF arrives in your inbox in about 2 minutes
Welcome back! Get this one instantly:
Get the Worksheet
PDF arrives in your inbox in about 2 minutes
Please check your details and try again.
You're set — the toolkit is on its way to your inbox.
Built by Prescription Benefit Solutions, an independent pharmacy benefits consultancy. In 2025: 132 pharmacy benefit reviews for self-funded employers, averaging $469,000 in contracted savings per client.
A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Paste-Ready Verification Request
"The contract exhibit is the source of truth." A "stabilization period." A member-facing PDF offered as the formulary record. Reconciliation "handled operationally." Each phrase separates what you signed from what the system pays, and each check pairs the request with the answer that means keep pushing.
PASS 01
Seven Pre-Go-Live Checks
Pricing loaded rather than just signed, the effective date versus the rate-change date, the formulary you approved versus the one in the build, utilization management overrides, eligibility and accumulator transfer, guarantee measurement start dates, and a named owner for the January claims read. Each check names exactly what to request and what a complete answer looks like.
PASS 02
The Red Flags That Signal a Gap
"The contract exhibit is the source of truth." A "stabilization period." A member-facing PDF offered as the formulary record. Reconciliation "handled operationally." Each phrase separates what you signed from what the system pays, and each check pairs the request with the answer that means keep pushing.
ACTION PLAN
The First 90 Days
Days 1-30: send the request and run the seven checks against what comes back, escalating anything unanswered in writing. Days 31-60: pull the first two weeks of January paid claims and compare net cost per script to contracted terms by channel. Days 61-90: take the variance log to the PBM with claim numbers. A first-quarter correction is a configuration fix; the same conversation in April is a credit negotiation.