Service
PBM Oversight
Quarterly performance monitoring, scorecards, and ongoing accountability
A PBM contract without active oversight is a PBM contract that quietly drifts. TeliosRx provides ongoing PBM oversight on a quarterly cadence: scorecards measuring contracted performance vs. actual delivery, audit-rights execution against the PBM's claim data, and continuous accountability so contract guarantees don't get forgotten between renewals.
What's Included
- Quarterly PBM performance scorecard
- Discount, rebate, and dispensing fee guarantee tracking
- Claim-level audit against contract methodology
- Connect-program and ancillary fee monitoring
- PBM relationship management with senior account team
- Annual contract anniversary review with optimization recommendations
Our Process
- Establish baseline KPIs and reporting cadence
- Quarterly data pull and reconciliation
- Scorecard delivery and account review meeting
- Issue escalation and resolution with PBM
- Annual reconciliation and contract optimization recommendations
Who This Is For
Plans 1,000+ lives that want an independent fiduciary watching the PBM continuously rather than waiting for an annual surprise at reconciliation.