Plan Strategic Execution

Plan Strategic Execution to help you monitor or select your pharmacy benefit manager

Plan Audits
Plan RFP
Pharmacy Plan Audits

Is your PBM performing?

If your Pharmacy Benefits Manager (PBM) isn’t performing, we want to help. Our in-depth, comprehensive audits can help uncover missteps in plan performance, and keep your benefits plan running smoothly. With the ability and expertise to analyze and uncover your plan’s cost drivers, our experienced team leaves no stone unturned. Cobalt Rx offers the following types of audits:

Contract Pricing & Rebate Compliance Audit
A formal audit of your PBM can verify that your plan is receiving all contractually guaranteed rebates, pricing discounts and dispensing fees. This full-scale, claims audit includes evaluating the PBM fields for each claim.

Financial Audits
The financial contract audit involves a thorough review and analysis of the brand and generic discounts applied from the Average Wholesale Price (AWP) for retail, mail order, and specialty clams, plus ensure correct dispensing fees were charged. We also review claims contractually excluded from pricing guarantees. Doing a financial contract audit will provide you with a better understanding of your PBM contract which is extremely helpful in future contract negotiations.

Plan Design & Clinical Program Audit
The plan design audit and clinical programs audit involves a thorough review of how all plan details have been applied and in what order. We see the PBMs challenged with the complexity and amount of plan management rules and applying them correctly at point-of-sale. Imagine the cost of a single missed prior authorization (PA) on a specialty drug that should have been denied. The cost to the plan would be thousands per month, for a drug that according to the plan document did not medically qualify for coverage.
Pharmacy Plan RFP

It's time to find your perfect PBM

Our years of experience working with both good and bad PBM relationships have helped us develop a Request for Proposal (RFP) process that looks beyond the black and white of your situation, and works to find you the perfect PBM partnership.

Your relationship with your PBM is extremely important to achieving the goals of your benefits plan, and through the RFP process, we’ll develop a comprehensive document detailing your wants and needs for potential partners. Working in tandem with you, we’ll prepare a document specifying all needs and establishing an evaluation criteria for received proposals. We’ll then use the RFP document to elicit bids from potential vendors and help you select your new PBM. RFP preparation includes:

  • Developing a Project Charter detailing the objectives of the job, including completion. Charter includes Project description, deliverables and timelines, objectives and resource requirements
  • ‍Development of the questionnaire to go to all bidders and providing each bidder with plan data for claims reprice
  • Evaluation of questionnaire and claims reprice when returned from bidders
  • ‍Organization of a results document that includes findings and recommendations
  • ‍Coordination of presentations from finalist potential vendors
  • ‍Creation of timeline and facilitation of implementation once bidder is selected
  • Negotiation of contract