PBM Contract Clarity™
Forensic analysis revealing $2.3M in hidden costs and contract vulnerabilities
Total Exposure
$2.3M
Annual hidden costs identified
Savings Potential
$1.8M
Projected first-year recovery
Contract Gaps
17
Critical vulnerabilities found
Action Items
12
Immediate recommendations
This forensic analysis of ABC Corporation's PBM contract reveals $2.3M in annual hidden costs and 17 critical contract vulnerabilities. Our analysis identified significant gaps in rebate transparency, specialty drug pricing controls, and audit rights that expose the plan to systematic overcharges.
Key Findings:
Undisclosed Rebate Retention
Contract lacks transparent rebate pass-through language, enabling PBM to retain up to 40% of manufacturer rebates
Generic Dispensing Rate Gap
78% GDR vs industry standard 90%, indicating potential steering toward brand-name drugs
Specialty Drug Markup
Average 18% markup on specialty drugs with no maximum acquisition cost (MAC) transparency
Administrative Fees Inflation
Multiple overlapping admin fees without clear service definitions or audit rights
Immediate Action Required
We recommend immediate contract renegotiation focused on rebate transparency, specialty drug pricing controls, and expanded audit rights. Estimated 12-18 month ROI.