When selecting a PBM or pharmacy benefit administrator, plan sponsors tend to focus narrowly on the rates being offered upfront for services such as network development and rebate administration. But some of the frequently overlooked aspects of the agreement — such as terms, definitions and the responsibilities of the parties — can contribute tremendously to the overall effectiveness and satisfaction with the contract … and the long-term relationship between the parties. Learn what a pharmacy benefit consultant and pharmacy benefit attorney recommend in order to secure a positive, effective relationship through the contract terms between PBMs and plan sponsors.
The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.
When it comes to contracting and managing relationships with respect to PBM services, purchasers often focus on rates (e.g., network, rebates and per-claim administrative fees) as the key decision-making components. Agreement on the terms, conditions, definitions, services and responsibilities of each party (i.e., non-rate components of the agreement) is often overlooked in the forefront of the procurement. Yet the non-rate components of the contract are a significant driver of the overall value and satisfaction of the relationship between the parties. Learn how greater attention to these non-rate components can help you avoid costly misunderstandings between the parties.
Hear two industry experts highlight key things to consider in PBM contracting, discuss how to avoid misunderstandings down the road, and offer strategies for all parties to secure a strong relationship and greater value in PBM contracting. You’ll get reliable answers to these and other big-dollar questions:
HELEN SHERMAN, R.Ph., Pharm.D., is vice president at Solid Benefit Guidance, where her lifelong commitment to advancing the best use of medications supports both SBG’s pharmacy consulting and employee benefit clients. Helen is an advocate of health care transparency and value and focuses on using solid scientific evidence as a foundation for health care decisions. She is dedicated to helping clients develop effective solutions in a dynamic and evolving health care marketplace. Helen has comprehensive leadership expertise in pharmacy benefit management, including business development, market evaluation, clinical services, rebate management, sales, account management, operations, claims processing, customer service, Medicare Part D, Medicaid, regulatory requirements and vendor/system transitions. Helen will employ her vast knowledge of pharmacy benefit management and her commitment to using evidence-based medicine for valuing medications to negotiate favorably for SBG clients. Helen has 15 years of experience in the health plan/pharmacy benefit industry, including vice president for business development and chief pharmacy officer for RegenceRx. She is an internationally recognized speaker and sits on several industry boards, including the advisory board of Drug Benefit News. Helen graduated from Oregon State University with a B.S. degree in Pharmacy and has a Pharm.D degree from Purdue University.
SAM BROWN is an attorney with The Phoenix Law Group. She is a partner in the firm’s Pharmacy Benefits and Operations Practice Group. Sam is a 1991 honors graduate of the University of Missouri, Kansas City, School of Law. She has been a lawyer in the PBM industry since 1998. After serving as vice president, assistant general counsel at AdvancePCS (now CVS Caremark Corp.), Sam became a founder of The Phoenix Law Group in 2003. The Phoenix Law Group is one of the few law firms in the country with an entire practice group devoted to the PBM industry, and the PBM practice group is made up entirely of attorneys that have in-house counsel experience. Sam represents clients in a wide variety of PBM-related matters, including regulatory compliance counseling, contracting, mergers and acquisitions, dispute resolution, licensing, policies and procedures, and responding to government investigations, inquiries, and proceedings. She works with client business and legal teams to understand their business goals and provide practical advice and workable business solutions. Prior to her experience in the PBM industry, Sam represented clients in corporate bankruptcy and restructuring matters and complex commercial litigation matters, as an attorney with Streich Lang, a prominent Phoenix law firm (now Quarles & Brady), and Cohen & Cotton (now Cohen Kennedy Dowd & Quigley), a litigation boutique law firm. She is also a co-owner in PLGTrack.com, which is a Web-based legislative and regulatory tracking service, identifying new laws and regulations passed by the state and federal governments relevant to the PBM industry.
Moderator: Lauren Flynn Kelly, editor of AIS's Drug Benefit News
Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at
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