Service
PBM Contract Negotiation
Clause-by-clause analysis and redline negotiation
A PBM contract is 100+ pages of definitions, exclusions, and reconciliation methodologies. The expensive parts are not the headline rates, they are the clauses that quietly transfer cost from the PBM to the plan. TeliosRx audits your contract against more than 60 clause-level red flags, redlines the high-impact terms, and negotiates directly with the PBM to get them changed. We work with both renewal contracts and net-new agreements.
What's Included
- Clause-by-clause contract review against TeliosRx red-flag framework
- MAC list transparency requirements
- Rebate guarantee structure and exclusion analysis
- Audit rights and reconciliation timing
- Channel-netting and liability cap review
- Specialty drug definition and pricing methodology
- Negotiation directly with PBM through execution
Our Process
- Receive current contract or PBM-proposed contract
- Run full clause-level review and document red flags
- Build redline draft with priority changes
- Negotiate with PBM through several rounds
- Final review and execution
Who This Is For
Plan sponsors at renewal, plans switching PBMs, and plans that want a fiduciary review of their current contract before signing year-over-year.