News|Videos|October 31, 2025

What Health Plans Should Ask For in Their PBM Contracts If They Want Transparency | AMCP Nexus 2025

Milliman's Jennifer Cruz, Pharm.D., said health plans should be able to track rebates to their book of business and have strong audit rights.

A lot of times with pharmacy benefit managers (PBMs), health plans asking about rebates will get information about the rebates for their book of business or their benchmarks, says Jennifer Cruz, Pharm.D., a pharmacy benefits consultant for Milliman.

"With a transparent PBM, you know exactly what was paid. You know what the rebate is. You can track that back on your book of business, instead of their benchmark or their book of business," Cruz said in an interview with Managed Healthcare Executive.

Cruz was a panelist at a session on emerging trends and best practices in health plan PBM contacts this week at the Academy of Managed Care Pharmacy (AMCP) Nexus 2025 meeting held in National Harbor, Maryland.

Cruz said it was important for health plans to get information about rebates specific to their health plan because, especially for small health plans, the overall picture for the PBM may not apply to particualr plan.

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