Workflow · Employee Health & Benefits
Pharmacy Review
Runs the pharmacy deep dive a benefits consultant does before a contract expiry or market check: rebuilds the prescription drug spend baseline, measures what the pharmacy benefit manager actually delivered against every guarantee in its contract, reviews the contract terms that decide who keeps the money, and turns the gaps into quantified opportunities.
What goes in
The pharmacy benefit manager contract with its pricing and rebate exhibits, the annual claims and utilization report, rebate statements, invoices, plan design and formulary documents, and top-drug or high-cost drug reports — plus, optionally, any market check, benchmark, or competitive bid data to compare the terms against, and the client's stated constraints.
What you get
A Pharmacy Review Report as a native Word document: executive summary, the pharmacy spend baseline with the channel table and per-member-per-month cost, the guarantee reconciliation showing contracted versus achieved with the dollar gap for every channel, the contract terms review, the utilization and clinical findings, the prioritized opportunities with their value and next step, the data gaps and requests, and the pharmacy roadmap.
How it works
- 1Establish the engagement: confirm the covered population, the pharmacy arrangement, the contract term, the review period, and the client's objective, then upload the contract, claims, invoices, and rebate statements.
- 2Rebuild the baseline: drug spend is computed by channel and in total — plan paid, member paid, net of rebates, per-member-per-month, generic dispensing rate, and specialty share — and reconciled against the invoices.
- 3Reconcile the guarantees: the achieved discount, dispensing fees, and rebates are measured against each contracted guarantee, channel by channel, and every gap is converted to dollars.
- 4Review the contract: pricing model, rebate definitions and exclusions, specialty list control, audit rights, and market-check provisions are each classified favorable, unfavorable, or absent.
- 5Deliver: a Pharmacy Review report as a Word/PDF document with recoveries already owed under the contract, contract-cycle actions, and strategic moves, prioritized.
Related pages
What this workflow delivers
A Pharmacy Review Report as a native Word document: executive summary, the pharmacy spend baseline with the channel table and per-member-per-month cost, the guarantee reconciliation showing contracted versus achieved with the dollar gap for every channel, the contract terms review, the utilization and clinical findings, the prioritized opportunities with their value and next step, the data gaps and requests, and the pharmacy roadmap.
6+ hours
- Guided step by step, no blank page
- Owners and follow-up on every run
- Human review before sign-off