June 13, 2026
[PBM / TPA name]
Attn: Account Management
Re: Document and information request, [Your organization] pharmacy benefit plan
To whom it may concern,
As part of our ongoing oversight of the [Your organization] pharmacy benefit, we are requesting the following documents and information for our review and records:
- The complete PBM/TPA agreement, including every exhibit, schedule, and amendment.
- Rebate pass-through terms and guarantees, and our right to reconcile them.
- Our audit rights as written, and any audits performed in the last 24 months.
- A complete schedule of administrative and all other fees charged to the plan.
Please provide these within 30 days of the date of this letter. This request is made in connection with our review of the plan’s terms and economics and our responsibility to confirm that the plan’s compensation and pricing are reasonable. Complete and timely responses help us meet those obligations.
Please direct your response to the undersigned. Thank you for your prompt attention.
Sincerely,
[Your name][Your title][Your organization]