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Pharmacy Benefits and PBM Contracting

Maximizing Your Health Plan Position in Complex PBM Contract Negotiations

With annual drug expenditures growing into the billions of dollars and increased government regulation of drug pricing and benefits, how health plans offer and administer pharmacy benefits is a complex and costly matter  The mechanics of drug pricing and contracting with pharmacy benefit managers (PBMs) are complex, nuanced, and rapidly evolving. For over two decades, our team has been at the forefront of revolutionizing how health plans navigate these intricate partnerships.

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PBM Policy & Legislative Update — Winter 2024


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Our Approach

Engaging at every stage of the procurement process, Mintz empowers health plans to navigate PBM negotiations with confidence by leveraging our breadth and depth of experience to mitigate risks and seize opportunities. Mintz provides comprehensive legal guidance to health plans throughout negotiations with PBMs to transform the delivery of pharmacy benefit services in commercial and government health care programs. Our seasoned attorneys adeptly unravel contract complexities by crafting clear, enforceable terms to establish responsibilities and optimize leverage and operational performance while anticipating regulatory and market shifts.  Our team has negotiated and drafted pharmacy benefit agreements with every major national PBM and many other entities in the pharmacy supply chain.  With extensive capabilities in crafting contracts for integrated and modular pharmacy benefit programs, we draft provisions that withstand negotiations with national PBMs, which ensures unmatched client advantages.

We are one of the few legal teams in the country who structure, draft, and negotiate “modular” PBM agreements, which break the traditional “all-inclusive” PBM agreement into smaller modular components to maximize competition, outcomes, and options for payers.

  • Structure, draft, and negotiate PBM agreements and amendments as well as drug rebate, purchasing, services, rebate aggregator, and limited distribution agreements.
  • Assist with Medicare Part D, Medicare Advantage, Federal Employee Health Benefit (FEHBP), and managed Medicaid contracting.
  • Structure health plan service arrangements, joint ventures, and affiliations.
  • Navigate outcomes and value-based drug purchasing arrangements.
  • Assist health plans and collaborate with plan consultants on the RFP process, including competitive PBM contracting that results in predictable timelines, leverages competition to optimize contract terms and conditions, and delivers a final agreement prior to implementation.

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