P3 allows brokers, consultants and companies determine if the current PBM contract terms in place are competitive or if other PBMs could provide more competitive terms.
P3 does two things.
You will need two things to start.
First, you will need the PBM contract that was executed between you (or your client, if you are a broker or consultant) and the PBM. Turn to the section called “Financial Performance Guarantees” or “Rates” or Financial Terms. That section will tell you what the discounts off Average Wholesale Price for retail, mail order and specialty drugs, as well as rebate guarantees and administrative fees.
Note: P3 works best for two tier plans with discounts for brand and generic drugs. 3 or 4 tier plans are not as well supported at this point.
The second item you will need is claims data for one year. Click here to find the fields of information we need for the claims data. the claims data is line item transactions taht tell us what drugs have been dispensed, when the claim was processed, and the details of the cost of the transaction.
You will get a report. Click here to see a sample. The report will show you the “reported” terms – the terms which the PBM said it would perform – compared to the terms at which the PBM is actually performing. This will tell you if the PBM is under performing and costing your plan needlessly.
The report will also show you leading PBMs’ terms and how those PBMs would have performed had you (or your client) had that PBM in place for the same time as the data you submitted.
There are two action steps. If the PBM is under performing, you should contact your PBM to determine why and see if there is a refund in your near future. The second step is contact one or several of the PBMs that show that they can save you money. You might be pleasantly surprised that these PBMs are helpful and can detail more about their programs and savings opportunities.
The report contains hyperlinks. Each PBM must post their contract terms. This allows the purchaser to understand what they are getting into before buying. You can compare termination clauses, definitions of brand, generic and specialty drugs and liability clauses BEFORE you buy. You wouldn’t buy a car before a test drive…don’t buy PBM services before you read the contract.
Yes. For seasoned PBM veterans, you can input key data and “do it yourself.” Inputting the data yourself means that you will get the report information quicker. But you will have to know how to read a PBM contract and it may take some reformatting of PBM data.
If you have a day or two, and especially if you are new to the prescription drug industry, enlist our concierge service. We will walk you through, step by step how to use the system or we will enter the data for you and send you a report. Don’t worry and don’t get frustrated. After a few reports, you will be an “old pro.”
Do you want VIP service? If you really have not “dug deep” in prescription drug programs or do not want to or don’t have time to collect the data and contract yourself, click here. Complete this document letting us contact your PBM and uplaod it. We will get a copy of your contract and claims data and will send you a report as soon as the data is ready, with email updates on the report status.
Pharmacy Investigators and Consultants is a privately owned company with no debt. We are also a Women’s Business Enterprise (WBE). We have never taken money (or anything else including rebates, commissions, marketing allowances or trips to Barbados in the winter) from PBMs for consulting services. We developed P3 as a tool for ourselves and then realized the applicability for other consultants, brokers and employers. Why not share a good thing?
PBMs do not pay to play, meaning that they do not pay to be on the platform. They (and us) also get no additional kick-back or commission if they land a client as a result of P3.
Transparent, Resourceful, and Cost Effective – that’s our promise to you.
Any questions and you can contact us at: mike.foster@pharmout.com or at 847-540-9590 ext (106).