September 2, 2025
Pharmacy benefits represent one of the largest and most complex cost drivers for health plans and employers. Every year, pharmacy benefit managers (PBMs) oversee billions of dollars in drug spend, making it essential for plan sponsors to review their contracts on a regular basis. With drug costs continuing to climb, sponsors must ensure their agreements deliver competitive pricing, transparency and alignment with member needs. Even if an organization believes it’s done everything it can to manage costs and service levels, there are always options to drive further improvements that can make a significant impact. A well-executed, objective PBM request for proposal (RFP) process not only helps achieve these goals but also reinforces an organization’s fiduciary responsibility to manage plan dollars wisely.
Quick Takeaways: Why a PBM RFP Belongs in Your 2026 Strategy
- Confirms your PBM contract delivers competitive pricing and rebate guarantees.
- Ensures transparency and compliance with evolving regulations like the CAA.
- Strengthens your fiduciary responsibility to manage plan dollars wisely.
- Provides leverage to negotiate clearer terms and protect member health outcomes.
- Offers a structured process to evaluate PBM services, digital tools and reporting.
How a PBM RFP Protects Plans and Their Members
1. Ensure alignment with industry changes.
A pharmacy benefit RFP can confirm your chosen PBM partners are prepared to address current and emerging industry trends, manage key cost drivers and navigate evolving regulatory requirements. It also demonstrates their ability to deliver long-term value, innovation and alignment with your plan’s strategic goals.
2. Gain clarification of contract terms.
A structured PBM contract evaluation provides plan sponsors with leverage to negotiate more favorable terms and definitions, including rebate guarantees, transparent pass-through pricing, audit rights to ensure accountability, specialty drug pricing and performance metrics. This protects a plan’s financial health and maximizes value for members.
3. Evaluate PBM services.
Through an RFP process, plan sponsors can thoroughly evaluate the full scope of PBM services, including:
- Member support: How PBM responds to member inquiries, manages escalations and delivers member assistance.
- Clinical programs: The PBM’s approach to formulary design, specialty drug management, adherence programs and overall member health outcomes.
- Data and reporting: Accuracy of claims, transparency of reporting and actionable insights provided.
- Digital capabilities: The strength of digital tools, data analytics and cost-containment strategies offered to support smarter decision-making.
4. Benchmark pricing.
Conducting a PBM RFP serves as a critical market check to validate pricing competitiveness and ensure fair pharmacy benefit cost management. It can uncover hidden contract language and prevent plans from overpaying due to outdated terms. In addition, the process creates leverage for improved rates, stronger rebate guarantees and contract provisions that drive greater transparency and long-term value.
5. Uphold fiduciary responsibility.
RFPs enable plan sponsors to fulfill their fiduciary responsibility to members by ensuring prudent PBM selection and accountable stewardship of plan dollars, as outlined in the Consolidated Appropriations Act (CAA) of 2021. To maintain compliance and protect financial integrity, sponsors should complete this evaluation every three to five years under a well-written contract, supplemented by regular market checks.
Conclusion
Conducting a pharmacy benefit RFP process is about more than securing the most competitive pricing. It’s also about finding the right partner who delivers sustainable value to both the plan and its members. With pharmacy benefits costs continuing to rise, plan sponsors must take a proactive approach to manage spend while protecting member health and outcomes. A knowledgeable pharmacy benefit consultant can guide the entire RFP process, from identifying the right PBMs to invite, to normalizing their responses for an equal and fair comparison, to negotiating a transparent, member-focused contract and ensuring a smooth implementation that minimizes member disruption. The result of this collaborative process is not only cost savings, but a long-term strategy that balances financial stewardship with quality care.
Ready to strengthen your PBM strategy? Book a meeting with our pharmacy benefit consultants today.
