Ensure Your RFP Process Yields the Greatest Results for Your Pharmacy Benefits Plan

Ensure Your RFP Process Yields the Greatest Results for Your Pharmacy Benefits Plan

Issuing RFPs is essential to maintaining a competitive, cost-effective pharmacy benefits plan. Requesting proposals from various PBMs ensures your plan remains aligned with the evolving needs of your plan members, meets your fiduciary responsibility to them and fulfills the latest regulatory requirements. A well-structured RFP process will help you secure the best pricing, terms, transparency and outcomes for your employees and their beneficiaries.

To conduct the most effective RFPs, consider these factors:

1. Strategize Early and Often
Strategy is key in developing a pharmacy benefits plan that meets your objectives.

• 2 Years: If you’re issuing an RFP, start strategizing 2 years before it’s issued.
• 10 Months: Launch the RFP at least 10 months before a potential change or the go-live date of a new contract to allow time for planning. 
• 4-6 Months: If you’re changing PBMs, give yourself at least 4-6 months to complete the process and test claims to ensure everything works.
• Future: Even with a current plan in place, you should continually evaluate where you want your plan to be in six months, a year, three years and even five years down the road.

2. Gain Clinical Insight
Clinical insight is key when evaluating RFP responses. If a PBM says it will offer pharmacy benefits cost reduction, it’s essential to understand how they will achieve that. For example, they may promise substantial rebate savings, but if their formulary is set up to spend a lot on medications, it will not save your plan money. Or they may require your plan members to move to specific pharmacies to access better pricing, which may be a disruption you’re not willing to make in your plan.

3. Employ Expert Analytics
When comparing different PBMs during the RFP process, recognize that it’s not a simple one-to-one comparison. The big three PBMs, transparent pass-through pricing, AWP pricing, NADAC pricing, rebates, rebate credits and many other considerations make the RFP evaluation process confusing. Expert analytics are required to dive deep into the details and determine which PBM will provide an Rx benefits plan design that best meets your organization’s needs.

4. Involve a Variety of PBMs
There are 80 PBMs on the market; new ones are constantly coming on. By engaging a variety of PBMs with different pricing models, service structures and contract terms in the RFP process, you create a competitive bidding process that helps you fulfill your fiduciary responsibility and maximize your savings.

5. Avoid Issuing an RFP Every Year
Conducting an RFP every year is not only time-consuming, it will also wear out the market and eventually exhaust any potential savings opportunities. However, that doesn’t mean you should simply let a three-year plan coast along without doing your due diligence every year to ensure your contract is solid and your advisors aren’t conflicted.

Ultimately, a well-executed, thorough RFP process will meet your fiduciary responsibilities and ensure your pharmacy benefits plan is cost-effective and aligned with the needs of your plan members. Ensure you’re working with a pharmacy benefit consultant who will analyze every element of a potential PBM’s contract, including rebates, clinical programs, terms and definitions, to build a strong contract and a plan that will benefit your organization and your plan members.