The PBM required solutions catered to strengthening its operational efficiency and bolstering its economics while continuing to support its client-facing business model. Within the network contracting market, there are several pathways that lead to accomplishing these goals, but few that afford the required level of transparency and value maximization.

The Proper team conducted a benchmarking analysis of the PBM’s current retail network contract economics and terms against industry competition. Faced with contract pricing that was lagging in the market, along with obsolete definitions and caveats, Proper recommended seeking competitive bids from several vendors.

Upon selection of a new vendor, the Proper team was engaged in validating, reviewing, and negotiating the proposed agreement’s financial savings estimates, terms and conditions, and functional requirements. The new agreement necessitated significant business process enhancements in conjunction with its strong financial benefits. The Proper team facilitated the creation of repeatable, efficient processes leveraging existing data structures to measure and interpret improved performance and associated value as well as adherence to contractual obligations.

Proper partners with the PBM to identify inadequacies within their network and pricing management. After conducting a diagnostic, Proper can determine and offer the following solutions depending on client specific situation:

• Develop a complete repository of all network pharmacy and client contracts
• Build a centralized data warehouse as a signal-source of truth with daily claims updates
• Create automated dataset and dashboards to reconcile client and pharmacy contracts in near-real time
• Collaborate with the client’s Plan Build configuration team to reconfigure the adjudication system in a manner to efficiently manage client and pharmacy side pricing
• Implement network pharmacy and client specific pricing changes