Direct Pharmacy Contracting
Form 5500 PBM disclosure mining, drug-by-drug Cost Plus equivalent savings models, and state PBM transparency law hooks. Five minutes from metro target list to pitch packet.
How it works
Real reports built from public Form 5500 disclosures and live drug spending data. Sponsors anonymized; every number, carrier, and trend is from an actual 2024 plan-year filing or CMS Part D release.
Query
“Find self-funded employers in the Phoenix metro with 1,500 to 5,000 participants. Top 5 by lives. Surface current carrier and any disclosed PBM signals on Schedule A or Schedule C.”
Real Form 5500 data; sponsor names anonymized. Real output includes EIN, sponsor address, and admin contact for CRM import.
| Sponsor | Industry | Lives | Health carrier | Funding | Flag |
|---|---|---|---|---|---|
| Sponsor A | Banking | 3,472 | Cigna Health | Self-funded | PBM carve-out |
| Sponsor B | Trades / multiemployer trust | 3,246 | Cigna Health | Self-funded | PBM carve-out |
| Sponsor C | Non-profit services | 2,944 | Cigna Health | Mixed | $6.48M premium |
| Sponsor D | Trades / multiemployer trust | 2,138 | Delta Dental | Self-funded | ASO + ancillary |
| Sponsor E | Construction | 1,797 | Cigna Health | Mixed | $138K broker comm |
Follow-up query
“Pull the full dossier on Sponsor A. PBM stack, broker compensation, ASO carrier, any prior renegotiations visible in the filings, estimated Rx spend exposure based on industry and headcount.”
Anonymized sponsor; numbers from 2024 Form 5500 filing
| Sponsor | Sponsor A (anonymized) |
| Industry | Banking / NAICS 522110 |
| Metro | Phoenix, AZ |
| Participants | 3,472 |
| Funding type | Self-funded (medical) + insured ancillary |
| Current carrier (Sched A) | Mixed: dental + life carriers disclosed |
| PBM disclosure (Sched C) | Not separately filed in most recent year |
| Disclosed broker commission | $0 across reported contracts |
| Plan year end | 2024-12-31 |
| Estimated Rx spend exposure | ~$8.3M annually (industry + headcount benchmark) |
Follow-up query
“Build the savings model. For the top 10 high-spend drugs in a self-funded plan of this size, compare incumbent PBM cost against NADAC + Cost Plus equivalent. Anchor on Humira (adalimumab) and the GLP-1 category.”
Live Part D spending trend + NADAC acquisition cost + Cost Plus marketplace
| Year | Total Part D spend | Beneficiaries | Per beneficiary |
|---|---|---|---|
| 2019 | $1.21B | n/a | n/a |
| 2020 | $2.17B | n/a | n/a |
| 2021 | $2.91B | n/a | n/a |
| 2022 | $3.69B | n/a | n/a |
| 2023 | $4.42B | 61,474 | $71,898 |
| Drug | Incumbent PBM cost | Cost Plus equivalent | Estimated savings | Flag |
|---|---|---|---|---|
| Humira (adalimumab) brand | $71,898 / yr / bene | Biosimilar at ~$1,200 / mo | ~$57,500 / yr / bene | Highest impact |
| Ozempic (semaglutide) | ~$11,200 / yr / bene | Not on Cost Plus; PBM negotiation lever | Variable | Renegotiation |
| Imatinib (Gleevec) generic | Brand-priced in PBM tier | $15 / mo at Cost Plus | ~$8,400 / yr / bene | Pure spread |
| Rosuvastatin | Generic at PBM markup | $6 / mo at Cost Plus | ~$180 / yr / bene | Volume play |
| Apixaban (Eliquis) brand | ~$7,200 / yr / bene | Brand still under patent; generic 2028+ | Wait or negotiate | Watch |
What you can ask
Each prompt runs against real Form 5500 and CMS Part D data. Follow-ups carry context across the conversation.
Metro target list, transparent PBM go-to-market
“Self-funded employers headquartered in [metro] with 1,000-5,000 participants. Surface current PBM signals on Schedule A and Schedule C. Top 25 by lives, ranked by Rx spend exposure estimate.”
A quarter of warm prospects in under a minute. CRM-ready with EIN, address, and admin contact.
“Filter to plans that filed no Schedule C in the most recent year. Those are the ones where PBM compensation is hidden and the audit pitch lands hardest.”
Missing Schedule C on a large plan is a fiduciary-conversation trigger.
“Now layer in state PBM transparency law jurisdictions with active anti-spread bills in the last 24 months. Sort by regulatory tailwind.”
Pair the prospect filter with the regulatory hook.
Without Medistill
Buy a list-broker file (no PBM signal), or manual FreeERISA city-by-city. Half a day to a full day, no synthesis.
Cost Plus savings model for a known prospect
“For a 3,000-life self-funded plan in [industry], build the drug-by-drug Cost Plus savings model. Anchor on Humira, GLP-1s, imatinib, and the top 10 cardio statins. Annualized savings per drug, ranked.”
The pitch deck page that quotes the CFO their own savings number, drug by drug, in plain dollars.
“Layer in 340B effective rates for any drug where the prospect is a covered entity or referral-eligible.”
340B pricing is a different curve and a different conversation.
“Add IRA Maximum Fair Price for the 2026 IPAY list drugs. Flag any where IRA reduces the savings wedge.”
Honest accounting of where IRA already closes the gap.
Without Medistill
Cost Plus website lookup, one drug at a time. No NADAC overlay. No annualized model.
Compounding pharmacy direct-to-employer pitch
“Compounding 503A and 503B pharmacies pitching direct GLP-1, BHRT, ophthalmic. Find self-funded employers in [metro] with 500-2,500 lives, high female workforce concentration (NAICS 6211, 6244, 6113), and disclosed pharmacy benefit carve-outs.”
Compounding pitch is demographic-tuned. The pharmacy's calling list reflects who actually fills the customized scripts.
“Cross-reference against FDA 503A/503B inspection history for our pharmacy to pre-build the compliance assurance section of the pitch.”
Buyers run FDA compliance themselves; you might as well bring it.
Without Medistill
Not done. Compounding pharmacies pitch off referrals and word-of-mouth, not data.
Defensive book audit for an existing client
“Our existing client [Sponsor]. Pull every PBM-adjacent disclosure in their last 5 years of Form 5500. Are any indicators trending? Spread pricing exposure flags? Did they recently switch PBMs?”
Renewal defense. Knowing what the prospect's compete looks like before they bring in a new RFP.
“Same 5-year view across our top 20 clients. Which ones have indicators trending toward a PBM switch?”
Book-level early warning.
Without Medistill
Account manager memory plus carrier-supplied data. No multi-year trend.
Regulatory hook prospect map
“States with newly-enacted PBM transparency laws in 2025-2026. For each, list the top 20 self-funded employers by Rx spend exposure. Build the regulatory-hook outreach list.”
Sales motion timed to the political calendar. State law change is the buying trigger.
“Same query for pending bills with high probability of passage (track bill status). Pre-position the outreach.”
Lead the regulatory wave.
Without Medistill
NCSL portal browsing + manual state legislature scrape. Not done at any scale.
Drug spend benchmark for an RFP response
“Build a benchmark page for an RFP. For the top 50 high-spend drugs in a typical self-funded plan, show 5-year trend in Part D spending, beneficiary growth, unit price CAGR, IRA negotiation status, and Cost Plus availability.”
RFP responses live and die on the appendix. The appendix is one query.
“Add the per-state Medicaid utilization overlay to show payer-of-last-resort spend dynamics by drug.”
Medicaid utilization grounds the volume assumption.
Without Medistill
Manual 46brooklyn + Cost Plus + CMS file synthesis. Days of analyst work per RFP.
Why switch
FreeERISA, list brokers, 46brooklyn, Cost Plus website, internal transparent-PBM tooling: useful pieces, not the pitch packet a producer or founder walks in with.
Find self-funded employers in a metro
Find self-funded employers in a metro
Buy a list-broker file, no PBM signal
One query against 1.1M Form 5500 sponsors filtered by city, NAICS, headcount, funding type
PBM disclosure surfaced
PBM disclosure surfaced
Manual FreeERISA lookup, no synthesis
Schedule A insurance carriers + Schedule C indirect-comp flag automatic
Drug-by-drug Cost Plus benchmark
Drug-by-drug Cost Plus benchmark
Cost Plus website lookup one drug at a time
NADAC + Cost Plus marketplace + 340B effective rate joined per drug
Specialty drug spending trend
Specialty drug spending trend
Annual CMS Part D file, hand-built trend
Live Part D time series, beneficiary counts, unit price CAGR
State PBM transparency law hooks
State PBM transparency law hooks
Manual NCSL / state legislature scrape
3,345 bills × 52 jurisdictions, refreshed nightly, joinable to sponsor state
IRA Maximum Fair Price flag
IRA Maximum Fair Price flag
CMS IPAY list lookup
Per-drug is_negotiated flag and MFP value when present
PBM contract terms reference
PBM contract terms reference
PDF reading; manual extraction
303 federal PBM contracts, OPM letters, GAO / FTC findings, Claude-extracted
Compliance pre-screen
Compliance pre-screen
Skip until contract diligence
Run the prospect's compliance flags before the pitch
Conversational follow-ups
Conversational follow-ups
Re-export, re-filter, re-merge
'Now show me the ones in states with pending anti-spread laws' in one line
Output
Output
Spreadsheets and screenshots
Pitch packet: prospect summary, savings model, regulatory hook, contact info
Price
Price
Internal tooling (transparent PBMs) or list broker subs $5K-$20K/yr
from $199/mo per rep
Data coverage
Form 5500 sponsor universe
Schedule A insurance contracts
Schedule C service providers
CMS Part D spending trends
NADAC acquisition cost
Cost Plus marketplace equivalent
IRA Maximum Fair Price
State PBM transparency laws
Federal PBM contract terms
Target lists, prospect dossiers, drug-by-drug Cost Plus benchmarks, state PBM law hooks. One conversation, from $199/month per rep.