PRM RISK ASSESSMENT

Determine current PBM risk factors through three simple assessments

In today's complex healthcare landscape, the role of human resources in managing prescription drug benefits has never been more crucial. Recent high-profile lawsuits involving major corporations have underscored the importance of proactive and informed oversight of pharmacy benefits.

Step One

Top Drug Comparison

Are you liable for inflated out-of-pocket costs for your employees? Check for stark pricing differences between PBMs. Complete your own top drug analysis now.

Download Free Worksheet

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How do I check how much I pay for these medications?

1

Ask your account manager

2

Use your PBM portal

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Step two

PMPM Costs

Is your PBM passing through 100% of your rebates and committed to the lowest per member per month (PMPM) cost considering all the fees your organization is charged?

Chart comparing the average Per Member Per Month Cost of SmithRx versus typical Legacy PBMs and typical Pass-through PBMs.

Step Three

PBM RFP Compensation

Failure to conduct an open request for proposal (RFP) process puts companies in legal jeopardy. Is your RFP process legally sound? If you answer “yes” to any of the questions, you may be at risk.

Does your PBM contract include AWP and rebate guarantees?

Why does this matter?

Beware of discount-based contracting. Your discounts may increase every year, and yet your PMPM spend may increase as well. This should not happen, and is a clear indication that your PBM contract is not delivering real cost savings.  

Did you pay separately for the RFP process or was it subsidized?

Why does this matter?

Beware of "free" RFP offers from pharmacy consultants. These costs (up to $7 PMPM) are often built into the PBM's spread pricing, leading to higher drug costs. What seems free upfront ultimately increases your pharmacy spend.

Is your PBM involved in financial relationships with brokers or consultants?

Why does this matter?

PBMs that have financial arrangements with brokers or consultants can create conflicts of interest. These hidden payments, often passed onto the client, may lead to higher overall costs and reduced transparency in how your plan is managed.

Were all the top bidders for your PBM contract legacy providers?

Why does this matter?

If your consultant only provided legacy PBM options, there is a conflict of interest. Modern PBMs definitively provide the same level of service at lower overall pharmacy costs. Your RFP process is incomplete without these cost-effective alternatives.

Does your PBM contract include AWP and rebate guarantees?

Why does this matter?

AWP and rebate guarantees in many PBM contracts can be misleading, with large portions retained by the PBM or structured in ways that don’t deliver real savings. These guarantees are often not what they seem, exposing you to hidden costs.

Did you pay separately for the RFP process or was it subsidized?

Why does this matter?

Legacy PBMs often hide "free" RFP fees elsewhere in the contract. These costs are typically absorbed through higher drug prices or admin fees, meaning you may end up paying for the service indirectly through inflated costs in other areas of the agreement.

Is your PBM involved in financial relationships with brokers or consultants?

Why does this matter?

PBMs that have financial arrangements with brokers or consultants can create conflicts of interest. These hidden payments, often passed onto the client, may lead to higher overall costs and reduced transparency in how your plan is managed.

Were all the top bidders for your PBM contract established, traditional providers?

Why does this matter?

If your RFP only attracted bids from traditional PBM providers, you may be missing out on more transparent and flexible options. These providers often use complex pricing models and hidden fees that can prevent you from achieving the lowest costs.

Special

D.O.

Customer service is A1.  Had the pleasure of working with Mark on an authorization approval and he did an excellent job.  He also helped me with questions regarding my insurance.  It was a pleasure to deal with such a professional, friendly person.

K.S.

I spoke with a custom service rep named Tannen. They were very helpful and polite. My pharmacy was trying to charge me for medication that I’ve taken for 2+ plus years that had previously been completely covered. A quick conversation with Tannen and they volunteered to call the pharmacy for me and make sure the correct information was on file. Received a call back from Tannen and they had everything straightened out for me.

E.S.

Words can't adequately describe how pleased I am with the help I received from Smith Rx CSR Sara J. this afternoon. For nearly 90 minutes, she pleasantly, patiently and professionally guided me through the process of setting up an account, then spent time going through individual medications to ensure I got the best coverage possible. If I could put my gratitude in her paycheck, she'd be a millionaire!

M.C.

Sydney was my customer service rep... I cannot say enough good things about her. She went above and beyond to take care of my issues, figure out why the issues were happening, resolve THOSE issues, and put in a return call telling me that all was corrected and that I should be having no other issues with these prescriptions. She then offered to transfer me to the mail order group to get set up with them. If everyone at Smith RX is like Sydney, then I know I am in good hands.

K.L.

Kellie was so helpful in getting me set up with the specialty pharmacy.  Not only did she give me updates as we went through the process, but she also followed up to ensure they had my prescription and let me know when they mailed it to me.  You don't get friendly, pro-active service like this often.  I really appreciated her efforts.

K.O.

I spoke with Tonya (customer service rep) and she was so kind, understanding, and helpful. I was feeling very stressed and frustrated when I called, and Tonya was calm and compassionate. I really appreciated her empathy for my situation. She even called me back after we ended our call to let me know that she was able to authorize an override for 3 months so that my children could receive their medication. Tonya is one of the nicest customer service reps I have ever spoken with, and I am very grateful for her help.

D.D.

I phoned SmithRx after my pharmacy notified me that my prescription was not covered by my insurance.  The representative I spoke with first verified my information and upon my request emailed me a copy of my insurance information.  Next, she looked up the medication that was denied to verify coverage.  Once coverage was verified, she went a step further and volunteered to contact my pharmacy to ensure they had the correct member Rx ID# on file.  It turns out the pharmacy had old information on file.  The problem was addressed, corrected, and my prescription was ready to go.  The SmithRx representative was helpful, kind, and so informative.  As far as customer service goes, this was top notch.

F.D.

I was diagnosed with Stage 4 cancer in October 2022. My employer uses Smith RX for their prescription plan- I continued with Smith RX through COBRA. Smith RX assisted me with completion of a Patient Assistance Program for my immunotherapy script with the manufacturer that THANKFULLY saved me thousands of dollars per year. Their team has also assisted me in attempting to access my medications for as low cost as possible. They even follow up to ensure my scripts have been received in a timely fashion. Their employees are extremely kind and easy to work with- they are knowledgeable, responsive and professional. When you are suddenly presented with a disabling disease, such as metastatic cancer, every interaction that saves stress contributes to overall health and a step toward healing.

D.H.

I dealt with a lady named Brittany. She was amazing.  She went above and beyond to ensure I was able to get everything I needed to have my son’s medicine at a very critical point in the refill process  She’s the kind of employee every company wants and I’m sure SmithRx values her very much. Thank you Brittany.

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