Plan Sponsor PBM Contract Services

In attempt to address the rising costs of prescription drugs, Plan Sponsors—including Self-funded Plans (employers, labor funds, public sector, federal), Health Plans (commercial, Medicare, Medicaid, and Exchange Plans), and Regulated Markets (Medicare, Medicaid, Public Health Exchanges)—have turned to the services of Pharmacy Benefit Managers (PBMs). PBMs act as “middlemen,” processing prescription medication claims. However, PBMs have taken advantage of their positions as “middlemen,” adding extra fees and charges to the process, usually for their own financial benefit, resulting in higher prescription costs for Health Plans and patients.

With an in-depth knowledge of PBMs and the Life Sciences space, Frier Levitt provides unique services to Plan Sponsors with the request for proposal process, contract review and negotiation, and audit of PBMs for contract compliance and rebate compliance. Frier Levitt works in Plan Sponsors’ best interests, helping to reduce costs and prevent any mistreatment or abusive practices.

 Frier Levitt has zero conflicts with representing Plan Sponsors against PBMs. Frier Levitt’s Plan Sponsor Practice Group works with Plan Sponsors to ensure PBM compliance with contracts and law, providing a variety of legal services, including, but not limited to:

  • Representation of Plan Sponsors in contractual negotiations with PBMs
  • Auditing of PBM performance and compliance with contractual and fiduciary obligations
  • Ensuring that Plan Sponsors understand their contractual rights and relationships with PBMs, including pass-through pricing and manufacturer rebates
  • Ensuring that Plan Sponsors understand their legal rights when PBMs have engaged in behavior that breaches a PBM’s contractual obligations and/or fiduciary duties, including situations where more aggressive legal action may be appropriate
  • Pursuing legal action against PBMs to enforce Plan Sponsor Agreement terms and conditions
  • Conducting and guiding Requests for Proposal
  • Reviewing and analyzing existing PBM Agreement
  • Drafting and negotiating PBM Agreement
  • Assisting Plan Sponsors with CMS Reporting and CMS Audit
  • Pursuing legal action against PBMs to enforce PBM Agreement terms and conditions
  • Providing regulatory compliance with respect to various Federal and State laws

How Frier Levitt Helps Plan Sponsors

Frier Levitt has observed troubling trends pertaining to PBM practices and the negative impact on Plan Sponsors. If you are a Plan Sponsor dealing with PBM contracts or are experiencing issues with a PBM, contact Frier Levitt today to speak to an attorney.