Pharmacy Benefit Managers (PBMs)

Pharmacy Benefit Managers (PBMs) operate at the intersection of regulatory compliance, pharmacy operations, plan administration, and client expectations. BluePeak helps PBMs strengthen compliance programs, support Medicare and government-sponsored business lines, optimize operational performance, prepare for audits, and successfully manage strategic initiatives ranging from implementations and transitions to benefit validation and oversight.

How BluePeak Can Help PBMs

Compliance & Audit Support

PBM Operations & Performance Optimization

Implementation, Transition & Vendor Oversight

Benefit Validation & Regulatory Guidance

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Client Favorites

PBM RFP Development, Review, and Contracting

BluePeak offers an industry-leading End-to-End PBM Procurement Process designed by former PBM Underwriters and Professionals. Our procurement process is designed around optimizing the final PBM service agreement and leads to better transparency and PBM partnerships. Plans can select the complete end-to-end process or we can customize a project to support any phase.

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PBM Implementations/Transitions

BluePeak can assist with PBM implementations and transitions. Our team will work with your team, your existing PBM, and your incoming PBM to ensure a successful go-live. We offer a wide array of implementation and transition support services to help ensure that a vendor transition is smooth and successful.

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PBM Audit

Comprehensive PBM audits to evaluate contract compliance, pricing accuracy, rebate pass-through, and overall performance against benchmarks.

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Call Center Assessment & End-to-End Monitoring

While no longer a CMS requirement, CMS can audit Call Logs as part of CPE Audits. The BluePeak End-to-End Call Log Review can help you identify and correct misclassification issues that might be detected in a program audit, including Part C and/or Part D Call Log Review, Call Recording Monitoring, and Training and Process Improvement.

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How We Deliver Results

Team Analyzing Data

Building Compliance Confidence and Marketing Clarity to Required Materials with Arkansas Superior Select

BluePeak guided a Medicare-Medicaid Plan’s transition to a FIDE and CO D-SNP by developing two fully compliant Models of Care (MOCs), aligning operations, and building a framework for long-term performance. Both MOCs achieved near-perfect NCQA scores and secured three-year approvals.

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Health insurance concept, wooden blocks with healthcare medical icons on blue background

How BluePeak Developed a High-Scoring Model of Care and a Framework Structure for an Overall Quality Program

BluePeak guided a Medicare-Medicaid Plan’s transition to a FIDE and CO D-SNP by developing two fully compliant Models of Care (MOCs), aligning operations, and building a framework for long-term performance. Both MOCs achieved near-perfect NCQA scores and secured three-year approvals.

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Puzzle Pieces

Neighborhood & BluePeak Successfully Executing a Competitive Medicare Bid

BluePeak guided Neighborhood Health Plan of Rhode Island through its transition from an MMP to a DSNP by providing end-to-end bid strategy, financial analysis, and compliance support. The result was a successful, on-time CY2026 bid submission with no CMS issues and a strong foundation for launch.

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Dart hitting its bullseye

Perfecting Compliance: How BluePeak Helped a Client Achieve a Flawless CMS Audit Score

BluePeak supported a long-term client through full CMS Program Audit readiness and execution, delivering strategic guidance, real-time support, and cross-functional alignment. The result was a flawless audit outcome with a 0.00 score and no corrective actions.

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Knowledge. Experience. Trust.

These aren’t just words—they’re the foundation of everything we do.

BluePeak Advisors, a division of Gallagher Benefit Services, is a national healthcare consulting firm that helps health plans, PBMs, and provider organizations navigate Medicare, Medicaid, and commercial programs through practical, audit-ready expertise in compliance, operations, and performance.

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Rolling Meadows, IL 60008

info@bluepeak.com
630-694-5215

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