TIER 1 · PHARMACY BENEFIT REVIEW · TWICE-YEARLY FRAMEWORK
Six Categories. Twenty Audit Items.
The Twice-Yearly Pharmacy Benefit Review Framework.
A 2-page printable framework PBS uses for the twice-yearly PBR audit. Six categories, twenty scored items, paste-ready renewal agenda. Free download. Sent to your inbox.
Six PBR categories: financial, contract, clinical, member, vendor, strategic
Twenty audit items scored 1-5 against PBM data
Score interpretation: below 50 / 50-70 / above 70 with next-step paths
Use the PBR findings as your renewal redline agenda
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Bring the PBR to Renewal
Total score: 20-100. Below 50 = meaningful unrealized cost containment and member experience risk; bring full audit findings to next renewal cycle. 50-70 = focus the next 90 days on the lowest-scoring category. Above 70 = strong oversight position; shift focus to renewal readiness.
PASS 01
Run the Six-Category Audit
The PBR covers Financial Performance, Contract Compliance, Clinical Programs, Member Experience, Vendor Management, Strategic Position. Each category has 3-4 audit items (20 total). Pull the data package from the PBM and score each item 1-5 against the data.
PASS 02
Score and Interpret
Total score: 20-100. Below 50 = meaningful unrealized cost containment and member experience risk; bring full audit findings to next renewal cycle. 50-70 = focus the next 90 days on the lowest-scoring category. Above 70 = strong oversight position; shift focus to renewal readiness.
ACTION PLAN
This Quarter's Action Plan
Pull the six-category data and score the framework. Re-run six months later and write the period-over-period comparison. Use the audit findings as the renewal redline agenda. PBS can run the PBR for your plan as a standing twice-yearly engagement.