Are you using market check to validate your pharmacy spend?

As the pharmacy landscape evolves with high-cost specialty medications and volatile rebate arrangements, self-insured employers face mounting pressure to control costs without compromising care. One of the most effective and underutilized strategies is the annual pharmacy market check.

Market checks go beyond rate comparisons, to serve as a strategic review, safeguarding the plan against cost creep and ensuring alignment with industry benchmarks.

According to Milliman, plan sponsors should conduct formal market checks annually throughout their PBM contract period not just at renewal time. This proactive approach helps keep contract terms competitive and exposes hidden costs or outdated rebate terms.

Market checks are especially critical as specialty drug costs continue to rise. As noted by NFP outdated PBM contracts may not account for inflation, new high-cost therapies, or evolving formulary best practices. Regular checks ensure your plan doesn’t fall behind the market.

Leveraging Data for Smarter Decisions

A data-backed market check is far more impactful than a surface-level comparison. Plan sponsors should look for data partners that include a detailed evaluation of the plan, including:

- Spend by drug class or tier

- Utilization of biosimilars vs. brands

- Rebate performance and pass-through

- Pricing benchmarks, including AWP and NADAC

“Using a market check vendor changes the business of benefit management for Rx consultants,” explains Garret D’Antoni, Chief Revenue Officer at Prescription Care Management, “Tools like PCM save significant time and minimize the use of resources to evaluate and validate PBM contracts.”

Combining pharmacy market checks with data analytics platforms offers visibility into plan performance and gives employers the negotiating power they need.

Pharmacy market checks are no longer optional, they’re essential. In a climate of rising drug prices and increasing pressure on benefit budgets, annual reviews provide the clarity and leverage employers need to maintain a high-performing, cost-efficient pharmacy plan.