Advanced Pharmacy Concepts has reviewed agreements for clients contracting with PBMs, claims processors, rebate administrators, and contract pharmacies. Our clients include managed care plans, Blue Cross Blue Shield plans, retiree benefit plans, TPAs, self-funded employers, and Medicaid plans.

Pharmacy pricing and contracting is extremely complex and unless all factors that affect pharmacy pricing are carefully defined and phrased in the contract, organizations can incur significant and otherwise avoidable, hidden costs.

Pharmacy benefits are managed in a manner that is very different than other health care issues. The relationships between PBMs, health plans, pharmaceutical companies, and community pharmacies are very complex, and often filled with conflicts of interest. By and large, PBM services are not yet regulated by either state or federal regulations. As a result, the PBM industry, in general, engages in practices that result in hidden costs to clients. These practices range from developing spreads between pharmacy payments and charges to clients to behind the scenes drug switch contracts that increase the use of high cost pharmaceuticals.

APC is on your side with our contracting experience and direct knowledge of the pharmacy benefits industry.