Overview
Pharmacy benefit management consulting addresses the complex contractual, regulatory, and economic relationships between PBMs, health plans, employers, and pharmacies. MDT Expert Consulting provides access to former PBM executives, health plan administrators, and pharmacy economists who evaluate formulary design, rebate structures, spread pricing, and network contracting practices in disputes involving PBM transparency, fiduciary obligations, and the economic impact of formulary and reimbursement decisions.
Pre-Litigation Support
Before litigation, PBM experts help counsel understand the economic and contractual framework underlying the dispute. They analyze formulary files, rebate agreements, network contracts, and reimbursement data to assess whether PBM practices were consistent with contractual obligations, fiduciary duties, and applicable regulatory standards.
Litigation Support
In litigation, PBM experts assist in interpreting complex formulary and rebate data, evaluating the economic impact of PBM decisions on plan sponsors and beneficiaries, and assessing the adequacy of disclosure and transparency practices.
Arbitration Support
PBM experts in arbitration address commercial disputes involving PBM contracts, formulary agreements, and network arrangements. Their deep understanding of PBM economics and contracting practices allows them to efficiently address the commercial and regulatory dimensions of disputes.