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Members may download one copy of our sample forms and templates for your personal use within your organization.

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If a PBM enters into contracts with drug manufacturers and chooses to give rebates another name — like administrative fees or health management fees or grants — the PBM will arguably eliminate its obligation to pass through the financial benefits to its clients.

Moreover, a PBM can deprive its clients of rebates by ensuring the rebates are paid on a basis that is not attributable to the clients’ drug purchases.

Most PBM/client contracts contain core language in which PBMs define the term “rebates” and agree to pass through all or most rebates to their clients.

Here are three examples: This language may appear benign, but it is anything but.

Thus, notwithstanding that most PBMs claim their contracts are transparent, almost all PBM/client contracts limit clients’ ability to audit rebates.

Many PBMs accomplish this task by inserting a single word into their contracts: proprietary.

Before our clients select a finalist, we insist that all semifinalists execute our contract, binding themselves to all that they have promised to provide during our process.

Our contract’s audit provisions include several paragraphs related to rebates and all other financial benefits, all as defined in our contracts.

Our RFP experience demonstrates a significant reality of the current PBM marketplace: PBMs’ executed contract terms — not their representations — are what matters.

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