Quarterly Review Agenda
- 1Net cost performance: Actual vs. guaranteed net cost
- 2Generic dispensing rate: Actual vs. target GDR
- 3Specialty cost: Actual vs. benchmark specialty cost PEPM
- 4Adherence rates: Actual vs. target adherence for chronic medications
- 5Member satisfaction: Member satisfaction scores and complaint rates
- 6UM performance: PA turnaround times; step therapy compliance
- 7Issues and escalations: Any problems with PBM performance or service
Annual Market Check
Conduct an annual PBM market check — getting competitive quotes from 2–3 PBMs — to maintain negotiating leverage. Even if you do not plan to switch PBMs, the market check provides: (1) current market pricing for comparison; (2) leverage for contract renegotiation; and (3) information about new PBM capabilities and programs. Share market check results with your current PBM to drive contract improvements.
Performance Improvement Plans
IQ Insight
PBMs who consistently miss performance targets should be placed on formal performance improvement plans (PIPs). A PIP defines specific performance targets, a timeline for improvement, and consequences for continued underperformance (including contract termination). PIPs signal to the PBM that performance accountability is real — not just a contract formality.