The Employer's Guide Blog for Overseeing PBMs

The Definition of Oversee: to watch over and direct (an undertaking, a group of workers, etc.) in order to ensure a satisfactory outcome or performance.

Proof: The People PBMs Hire to Hide Cash Flow From Employers

First, let me start by suggesting the position of PBM Pricing Strategy Analysis Manager is unnecessary if Anthem Inc. operated as a fiduciary rather than a FFS or fee-for-service provider. Better yet, this position is ultimately eliminated when employers across the country start to demand a fiduciary contract from their PBMs. This is a full-time position dedicated to drive PBM revenue growth. In fact, much of your PBMs margin protection occurs after you’ve signed on the proverbial dotted line!
Pay close attention to the buzzwords and phrases used in the job description such as underwriting, revenue performing below thresholds, and ASO passback. The point here is that traditional PBMs are armed with seemingly unlimited resources to maximize margin revenue from clueless employers. How much human capital and other resources are you allotting, throughout the course of the year, to stem PBM overpayments?
A retained national employee benefits consulting firm may not be enough to eliminate overpayments to PBMs. Trust me on this one. The simple fact is that most benefits consultants are not PBM experts rather really good connectors of buyers and sellers.

Self-insured employers and benefits consultants must have, at a minimum, highly trained [internal] PBM experts to address spiraling drug costs and improved patient outcomes. Those individuals with the same level of knowledge and resources available to PBMs in order to secure pharmacy outcomes aligned to plan goals.

Click the link below to view the actual job listing.


Job:  Provider Network Management
Location:  Reno
Requisition ID:  101783
Posted on: April 17, 2015

Job Description:

Anthem, Inc. is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions. Bring your expertise to our innovative culture where you will have the opportunity to make a difference in peoples lives, and to take your career further than you can imagine.

The PBM Pricing Strategy Analysis Mgr is responsible for Pharmacy Services pricing and Administrative Services Only (ASO) support functions. Primary duties may include, but are not limited to:

  • Implements new processes, process improvements, and best practices related to pricing, guarantee monitoring, and ASO passback activities.
  • Creates and implements metrics and supports performance measures to establish performance objectives for revenue maximization and pharmacy pricing.
  • Creates tools and processes to monitor margin revenue, pricing accuracy, and client retention.
  • Monitors revenue performing below thresholds and implements necessary tasks to bring performance to or above targets. This is the one which should scare the hell out of Benefits Directors, CFOs and benefits consultants; those plan sponsors who don’t have an effective process to measure billed amounts against actual acquisition costs (what the pharmacy actually paid to bring prescription drugs into inventory along with full audit rights of network and manufacturer revenue agreements).
  • Implements pricing in the system related to margin.
  • Supports the Pharmacy Services team in implementing future revenue, member expansion and growth capacity.
  • Assists with developing pharmacy pricing training to underwriters and updates to underwriting guidelines.
Requires a BA/BS in Finance or related field; 5 years of experience with a Pharmacy Benefits Management (PBM), pricing, data analysis; or any combination of education and experience, which would provide an equivalent background. MBA preferred.
Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2014 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company please visit us at EOE. M/F/Disability/Veteran.


Anthem Inc. isn’t the only traditional PBM which hires for this position. They all do so if you’re thinking “we dodged a bullet because Anthem isn’t our PBM” think again.

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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