START YOUR BENEFITS ASSESSMENT
START YOUR BENEFITS ASSESSMENT

PBM RFP Submission & Analysis

Identify & reclaim hidden pharmacy savings.

We assist organizations in evaluating and optimizing their pharmacy benefit programs to uncover overcharges and secure savings. Leveraging comprehensive auditing techniques and in-depth RFP analysis, we ensure your PBM agreements align with market standards and deliver on their commitments. Our proactive approach empowers you to take control of your pharmacy benefits, reduce costs, and maximize the value of your program.

  • Comprehensive PBM Audit
  • PBM Contract Language Requirements
  • Detailed Questionnaire
  • Generic MAC Analysis
  • New Generics and Single- Source Generic Analysis
  • Mail Service Package Size Analysis
  • Zero Balance Due Claim Analysis
  • Specialty Drug Discount Analysis
  • Manufacture Rebate Analysis
  • Pharmacy Claims Data Warehousing
Explore PMB RFP SUBMISSION & ANALYSIS

PBM RFP Submission & Analysis
optimize PBM vendor selection

One of the most critical differentiating features of Quantas Advisors is our ability to apply audited claims data to the PBM vendor-pricing evaluation process. Our proprietary pricing evaluation model gives Seneca Consulting the ability to accurately provide our clients with vendor comparisons, based on the projected cost savings of each prospective vendor.

our approach is different from most vendors.

SUBMIT A PBM RFP REQUEST
The complexities of pharmacy benefit program administration make it difficult for plan sponsors to validate their existing Pharmacy Benefit Manager (PBM) terms, and to determine if they are competitive in today’s marketplace. Our “Audit-Based” PBM vendor selection services mitigate these concerns through comprehensive pharmacy claim auditing, combined with detailed comparisons and projections.

Pharmacy benefit clients realizes a savings of 10–12%

Our average pharmacy benefit client realizes a savings of 10–12%. Our trend management capability flattens the trend curve to single digits each year. By proactively managing your pharmacy benefit, your organization will control costs and maintain a valuable benefit program for your members.

PBM RFP Submission & Analysis
our 3 phase approach

Quantas Advisors works with the needs of each client. The scope, timeline, and analysis of the RFP can be customized to meet your organization’s specific needs. Our Standard “Best Practices” PBM RFP Submission and Analysis service comprises three phases.

01

Phase I

Pre-RFP Analysis

Prior to the issuance of a comprehensive pharmacy benefit RFP, we will carefully provide the following services to aid in the development and potential release of your PBM RFP.

1. Comprehensive Pharmacy Claims Audit

Quantas audits a minimum of 12 months of pharmacy claims data from the current pharmacy benefit manager. Once received Quantas Financial will verify existing PBM terms and conditions to include but not limited to:
  • Contract Language Review
  • AWP Discounts (Retail, Mail, Specialty)
  • Drug Classification (Medispan vs. Current)
  • Dispensing Fees
  • Rebates

2. Current Market Analysis

Quantas will provide a Current Market Analysis using recent PBM terms offered for similar-sized employer groups. That Market Analysis will include:

  • AWP Discount Guarantee Comparison
  • Rebate Guarantee Comparison
  • Specialty Discount Guarantee Comparison
  • Potential Savings Analysis
Group 11

Phase II

RFP Preparation, Submission & Analysis

Utilizing the data provided in Phase I, we will establish and release a comprehensive PBM RFP to qualified PBMs, ensuring accurate vendor comparisons.

1. Request for Proposal Components:

  • Detailed Questionnaire
  • De-identified Claims Repricing Request
  • PBM Contract Language Requirements

2. Request for Proposal Evaluation Components:

  • Summary of Questionnaire with Comments
  • Summary of Claims Repricing
  • Summary of Savings Projections
Group 12

Phase III

PBM Performance Verification

Six months after implementing a new PBM agreement, claims data will be reviewed to ensure the PBM’s performance aligns with contracted terms:

  • Actual Achieved AWP Discounts
  • Pursue Recovery
  • Rebates Achieved

TALK TO A PRO

REQUEST A PBM RFP Submission & Analysis

SUBMIT A PBM RFP REQUEST

Things to consider while
evaluating your PBM

Quantas Advisors provides a thorough analysis to navigate the complexities of pharmacy benefits management. Using advanced data insights and industry expertise, we identify key trends and potential cost-saving opportunities while addressing PBM strategies that may impact your bottom line. Our approach ensures you maximize savings and maintain control over your pharmacy benefits program.
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RETAIL TO GENERIC SHIFT

Approximately 9% of the brand drugs dispensed via retail will be going generic in the next five years

MAIL SERVICE TO GENERIC SHIFT

Approximately 15% of the brand drugs dispensed via mail service will be going generic in the next five years

GENERIC FILL INCREASE

Generic fill rate is expected to increase 15–17% in the next five years

EXCLUDING NEW GENERICS

PBM strategy is to exclude new generics from discount guarantees

RECLASSIFYING GENERICS

PBMs can “reclassify” new generics as “brands,” to increase discount guarantee

Let us audit your
Pharamcy Benefit Manager.

And handle all the heavy lifting so you can focus on your business.
SUBMIT A PBM RFP REQUEST
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