PBM RFP Process Underway for 2022

Josh Bindl  •   October 7, 2020

Using Purchasing Power to Benefit our Members

The pharmaceutical industry is in a state of constant change. The upside to this change is the cutting-edge medications for patients; the downside is an uptick of tactics resulting in wasteful spending that hurts both patients and plan sponsors. To keep up, National CooperativeRx has expanded its watchdog role to be even more vigilant over the prescription drug spend of our membership.

The most fundamental function of the Cooperative, going back to our formation in 2003, is to use the collective purchasing power of our members to obtain the best discounts, rebates and contract terms from a pharmacy benefit manager (PBM). The process for a new PBM contract for January 1, 2022 has already begun and will result in a solution that continues to fill a plan’s duty to manage both cost and quality of a PBM vendor.

The Goals of Our Pharmacy Benefits Request for Proposal (RFP)

We start the process by hiring an independent consultant who will provide insights and ideas, as well as collaborate on innovations that our staff have for changes in any future contract. Those efforts are already underway. The RFP will go out to PBMs in the coming weeks.

The PBM marketplace is filled with ever-changing complexities — our current vendor very much included. The RFP process gives us an opportunity to analyze new pricing and transparency models to determine the best fit for Cooperative members. In our continued efforts to drive plans to achieve the lowest net cost, multiple pricing models will be considered.Call out box that says Accepting the status quo from a PBM is unacceptable.

We also look for greater levels of customer services, both for patients and plan sponsors. Accepting the status quo from a PBM is unacceptable. Employers need tools and flexibility to drive greater value from their benefits to attract and retain their employees.

Any new contract will continue to include the ability to do an annual market check. Pharmaceutical pricing is evolving quickly and any plan sponsor with pricing that is not updated annually is paying more than necessary. This continues to be important with specialty as new drugs coming to market can provide competition and drive down costs. Patients and plan sponsors should immediately benefit from marketplace changes.

National CooperativeRx RFP Timeline

Setting timelines in a PBM RFP is difficult. Our philosophy is the process will take as long as it needs to in order to drive the greatest value for our membership. With that said, our goal is to have initial feedback on results in January and be ready to share outcomes early in the second quarter of 2021. This will provide adequate time for the Cooperative team to present the new option(s) to current and potential future membership well in advance of the effective date.

Although we always work to renew every member of National CooperativeRx, we respect some members’ desire to do their own due diligence. Given a fair and honest analysis, not always the case in this marketplace, we trust the PBM contract we negotiate will come out on top. This timeline provides ample time for that as well.

Additional RFP Concerns 

If you have thoughts or concerns about our PBM options for the future, please contact me or any member of the National CooperativeRx team. We’re always happy to have a phone call and we’ve gotten pretty good at video calls too!

Thank you, as always, for being a member of National CooperativeRx.