Control Your Plan
Transparency is useful. Control is better. Your contract should give you the rights to access your data, verify what your PBM is doing, act on what you find, and leave when the relationship no longer serves the plan.
Three issues to read first.
Access Is Not The Same As Control
Data rights can give you access. Data sovereignty gives you the ability to control, verify, use, and move your information without depending on the PBM’s permission.
READ THE ISSUE →Mutually Acceptable Audit Rights
An audit right that lets the party being audited approve your auditor, limit the scope, or control the findings may look like oversight while functioning like a veto.
READ THE ISSUE →You Found a Better Deal. Now Read Your Contract.
Finding a better specialty, clinical, or pharmacy solution does not mean you can use it. The contract determines whether you retain the right to act.
READ THE ISSUE →Go deeper on the rights that preserve control.
The Lock That Seals Your Fate
Termination provisions can turn a better alternative into an option that is simply too expensive to use.
What Does It Cost You To Leave?
Data, audit rights, and findings have limited value if the contract makes leaving more expensive than staying.
Zero Out of Thirty
What contract data reveals about whether employers actually have meaningful, independent audit rights.
Found a Better Deal? Your Contract Says No.
Lowest-net-cost opportunities mean little when exclusivity, penalties, or rebate provisions prevent the plan from acting.
The Language That Moves the Market
Model language shows how audit, carve-out, and termination rights can be rewritten to restore control to the plan sponsor.
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