TIER 2 · MID-YEAR CLAIMS · RED FLAG CHECKLIST
Your Renewal Is Being Decided by June's Claims.
The Five-Pattern Mid-Year Red Flag Checklist.
A 2-page printable checklist PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
Five claims-data patterns that predict renewal trajectory
The data-pull request to run at the H1 mark
Intervention pathway for each pattern
Renewal-prep action per red flag
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Intervene Before Renewal
Five claims patterns predict renewal trajectory: specialty concentration shifts, generic-efficiency erosion, rebate-per-claim drift, high-cost-claimant emergence, and mail-order migration. Each is a flag the summary report hides.
PASS 01
Pull the Mid-Year Data
At the H1 mark, pull the claims data the checklist specifies. The patterns that will define your renewal are already in the PBM's system; the question is whether you see them before the PBM presents terms.
PASS 02
Scan Five Patterns
Five claims patterns predict renewal trajectory: specialty concentration shifts, generic-efficiency erosion, rebate-per-claim drift, high-cost-claimant emergence, and mail-order migration. Each is a flag the summary report hides.
ACTION PLAN
This Quarter's Action Plan
Run the data pull, score the five patterns, and act on the red flags now. Walking into renewal with documented mid-year findings flips the leverage back to the plan sponsor.