Milliman Dynamic Pharmacy Analytics

We are available to help clients audit their PBM arrangements to validate that the PBMs meet contractual integrity and financial obligations. We routinely perform audits of pharmacy claims, rebates, retiree drug subsidy, prescription drug event, performance guarantee, corporate compliance, and data validation.

We help clients write, negotiate, analyze, and audit their contracts with PBMs. We bring an understanding of the ongoing changes and current cost factors in the pharmacy benefits industry and use it to help clients obtain the most favorable contracts with the best pricing possible.

We help with vendor selection, including RFP development, PBM bidder selection, RFP fulfillment, proposal evaluation, and finalist selection.

We help clients create and analyze a robust pharmacy benefits plan model that also provides flexibility and affordability for both plan sponsor and plan members.

Once a PBM vendor has been selected, we provide PBM implementation oversight to ensure a smooth transition to the new PBM with minimal member disruption.

Our consultants can also work directly with a client’s PBM to provide improved economic control and a greater focus on quality of care and service to the plan’s members. This can help ensure the transparency of financial, clinical, and operational processes of the PBM operations, and also provides a way to manage cost with the integration of medical guidelines, disease management, wellness, and other clinical-based programs. On-going support and management we routinely provide to our clients includes reporting (monthly, quarterly, and ad-hoc), attendance at PBM meetings and presentations, independent assessments of cost and utilization statistics, and market checks for pricing terms for specialty and traditional medications.