The Short Version
✦Formal RFPs and informal evaluations fail the same way: the questions come from the incumbent's last proposal, so every vendor passes.
✦Organize questions by what the answer reveals, not by what the brochure covers: pricing incentives, formulary governance, the prescribing moment, daily operations, and the exit.
✦You do not need a procurement department to run a disciplined evaluation. You need the same questions asked of every vendor, with the answers written down.
✦Bring this list to every vendor. Including us.
Half the hospices we talk to run a formal RFP when they evaluate pharmacy vendors. The other half run on demos, references, and judgment. Both paths can work, and both fail in the same predictable way: the questions get written from whatever the current vendor's proposal covered, which means every vendor in the running can answer them comfortably. A comfortable evaluation is a sign the questions are wrong. The useful questions are the ones organized around what each answer reveals about how the vendor makes money, who controls your program, and what happens when you want to leave.
1. The pricing model, because it predicts everything else
What you are really asking: where does your revenue come from?
→Walk me through exactly how you make money on our account. A clean answer fits in two sentences. A long answer is the answer.
→Is pricing pass-through? Will the invoice show what the pharmacy was actually paid for each fill? "Competitive pricing" is not a yes. Line-item pharmacy reimbursement on the invoice is a yes.
→Show me the formulary change history for a current client over the life of their contract. A per-diem vendor's list that shrank, or a claim-based vendor's list that swelled, tells you whose interests steer the list.
→What is your position on 30-day fills for stable patients? A vendor paid per claim has a reason to love 14-day cycles. Listen for whether the answer is clinical or evasive.
→Do you retain rebates, own pharmacies, or share ownership with any pharmacy in the network? Any yes means some recommendations arrive with a thumb on the scale.
What you are really asking: whose formulary is this?
→Who sets the formulary, and what does it take for our clinical team to change it? Days and a documented process, or a committee you do not control?
→When a medication falls outside the list, what does the clinician see, and when? Before the order is signed is one kind of program. After the rejection is another.
→How do you handle requests to add a medication our IDG wants? The speed and spirit of this answer is the relationship in miniature.
3. The prescribing moment, because that is where cost and care are decided
What you are really asking: what does the prescriber know before signing?
→At the moment of prescribing, what exactly is on the screen: coverage, the contracted price, prior authorization status, interactions? Ask for all four by name. Vague answers usually mean a portal somewhere else.
→Is that answer an estimate or an adjudicated check? A coverage guess that dies at the pharmacy counter is worse than no answer, because someone trusted it.
→Can this run inside our EHR, and for health systems, inside Epic? Who logs in where, and how many systems does a nurse touch to get one order through?
4. Daily operations, because the demo never shows a Tuesday
What you are really asking: what happens when something goes wrong?
→When a claim rejects at 2 a.m., who finds out, how, and when? The answer should name a workflow, not a phone number.
→How are prior authorizations tracked, and who chases them? "We handle it" needs a follow-up: show me the queue.
→What does support look like after go-live: named people who know our program, or a ticket system? Ask who you will actually talk to in month nine.
→What metrics will you report monthly, and will you baseline them before go-live? A vendor unwilling to measure its own impact is telling you what it expects the measurement to show.
5. The exit, because the best time to negotiate it is before you sign
What you are really asking: what does leaving cost?
→What is the contract term, and what are the termination provisions? Long lock-ins are a confession about retention strategy.
→If we leave, what happens to our data, our claims history, and our pharmacy relationships? Get the export format in writing.
Scoring without an RFP
A disciplined informal evaluation needs only this: ask every vendor the same questions, in the same words, and write the answers down while they talk. A shared document with one column per vendor does what a forty-page RFP does, at a fraction of the ceremony. The discipline is in the sameness, because vendors are excellent at answering the question they wish you had asked. For a shorter starting set with our own answers on the record, start with the five questions.
A comfortable evaluation is a sign the questions are wrong.
Bring it to everyone, including us
We published this list knowing we will be on the receiving end of it, which is rather the point. A vendor whose model survives these questions should welcome them. Ask us the formulary history question. Ask us the 30-day fill question. Ask us how we make money, and then check our answer against the public version.
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