July 11, 2025
Self-funded employers face growing pressure to manage rising health care costs while delivering sustainable, high-quality benefits. Prescription drug spending is often one of the most significant—and least transparent—components of the total cost of care.
Running a Request for Proposal (RFP) for Pharmacy Benefit Manager (PBM) services is a pivotal opportunity to reshape your pharmacy strategy for years to come. Engaging a pharmacy consultant with deep clinical and financial expertise brings measurable value, both operationally and financially.
Understanding the Landscape: PBMs and Self-Funded Plans
Self-funded employers assume the direct financial risk for their pharmacy benefits. PBMs are third-party administrators that manage drug benefits on their behalf, negotiating with manufacturers, designing formularies, adjudicating claims and contracting with pharmacies.
However, the pharmacy benefit landscape is riddled with complexity, including rebate structures, formulary management, contract terms and definitions and hidden fees that can all impact plan performance. Without specialized knowledge, it’s easy to end up with the wrong PBMs in the process and a contract that fails to reflect the promises made during the RFP process.
This is where an experienced pharmacy consultant’s clinical insight, financial rigor and in-depth industry knowledge become invaluable, particularly when undertaking the crucial task of selecting a PBM partner through a rigorous RFP process.
The Strategic Value of a Pharmacy Consultant
1. Deep Market Expertise and Unbiased Guidance
A pharmacy consultant brings specialized knowledge about the pharmacy benefit landscape, including current market trends, PBM business models and the evolving regulatory environment. Unlike PBMs (who have a vested interest in selling their own products and services), an independent consultant acts solely in the employer’s best interests, providing objective, data-driven recommendations. Their expertise encompasses:
- Best practices in PBM contracting
- Comprehensive knowledge of pricing methodologies (spread pricing vs. pass-through, transparent vs. traditional models)
- Awareness of the latest cost-containment strategies and clinical programs
- Ability to benchmark PBM proposals against industry standards
This combination ensures recommendations are grounded in both the science of pharmacy care and the discipline of financial analysis.
2. Customized RFP Design and Objective Evaluation
One of the most significant advantages of engaging a pharmacy consultant is their role in designing and managing the RFP process. The consultant customizes RFP documents to reflect the employer’s specific needs, priorities and risk tolerances. This includes:
- Defining detailed scope and objectives for the RFP
- Crafting precise, comprehensive questions to elicit critical and comparable information from PBM bidders
- Developing scoring criteria that balance cost savings, member disruption and service (cost, transparency, clinical management, technology, service, etc.)
- Verifying that legal, regulatory and fiduciary obligations are addressed
With their experience, consultants can spot vague or misleading language in PBM responses and bring clarity to complex contract terms. They also facilitate a side-by-side analysis of proposals, highlighting key differentiators and potential pitfalls.
3. Negotiating Better Pricing and Contracts That Deliver Real Savings
Pharmacy consultants possess strong negotiation skills honed through years of industry experience. They understand the leverage points and typical areas for negotiation in PBM contracts—such as guarantees on discounts and rebates, definitions of specialty drugs, formulary flexibility and audit rights. Because they oversee multiple RFPs annually, consultants have access to current market rates and can push for highly competitive pricing and favorable contract language, often identifying hidden fees or unfavorable terms that may otherwise go unnoticed.
Pharmacy consultants bring negotiating experience to secure:
- Clear definitions for rebates, ingredient costs and specialty medications
- Strong guarantees tied to measurable outcomes
- Transparent audit rights and reporting
- Flexibility to adapt to market and formulary changes
This structured approach ensures that the final contract reflects the RFP commitments and sets the stage for accountability.
4. Ensuring Transparency and Accountability
Transparency is a major issue in PBM contracting. Many PBMs utilize opaque pricing structures, spread pricing or undisclosed revenue streams. A pharmacy consultant can demand clear reporting and robust audit rights, and request detailed disclosures on all revenue sources, including rebates and fees.
Additionally, consultants ensure that contract language includes measurable performance guarantees, service-level agreements and audit provisions—holding the PBM accountable for delivering on its promises.
5. Driving Value Beyond Cost Reduction
While cost savings are critical, the value delivered by a pharmacy consultant extends beyond dollars and cents. Consultants ensure that the chosen PBM aligns with the employer’s broader goals, such as member experience, clinical outcomes and long-term sustainability. They help evaluate:
- Clinical management programs (utilization management, adherence, disease management)
- Formulary design and disruption analysis
- Specialty pharmacy strategies
- Technology capabilities (member portals, mobile apps, data integration)
- Service models and support for HR teams
A holistic review ensures that together, these elements selected by the PBM will not only save money but also deliver high-quality service, support and innovation, and improve employee health outcomes.
Potential Pitfalls Without Specialized Support
Without a pharmacy consultant, self-funded employers risk:
- Accepting ambiguous or suboptimal contract terms
- Missing competitive pricing and rebate opportunities
- Failing to secure audit rights and market checks to verify performance
- Overlooking clinical gaps that undermine employee satisfaction and ongoing plan performance
The result? A vendor relationship instead of a true partnership—and a contract that doesn’t evolve to protect your plan over time.
The greatest myth that we see is that many employers underestimate the complexity of PBM contracts, mistakenly believing that all PBMs and their offers are essentially equivalent. There are over 80 PBMs in the market today.
Conclusion
Engaging a pharmacy consultant is a strategic investment in your plan’s future. A consultant with deep expertise in market trends, contract negotiations, clinical insight on program evaluations and formularies, and, most importantly, complete objectivity is critical to running an RFP process that produces a contract that delivers the promised savings, services and partnership you need and deserve.
