Pharmacy Benefits Manager - 100% Pass-Through PBM
houma, insurance, benefits, alford, tony alford, aslr
760
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100% Pass-Through PBM

Pharmacy Benefits Managers, or PFMs, act as the representative between the employer and everyone else in the healthcare system to process prescriptions.

We use a 100% Pass-through PBM.

  • Traditional PBMs make their money through up to 42 different revenue streams including Mail Order, Spread and Rebates in addition to many other techniques.
  • Transparent PBMs make money through up to 16 of the 42 revenue dtreams that traditional PBMs use, but have more restrictions than traditional.
  • Pass-Through PBMs make money ONE way. This is an administration fee and pass 100% of the savings on to the employer.

Under a traditional spread arrangement, the amount billed to the employer for the drug dispensed by the pharmacy is not necessarily the same amount the PBM pays the pharmacy. The difference is the spread, which the PBM retains as revenue. Most arrangements in place today apply some level of traditional spread pricing. In general, the discounts in a traditional spread arrangement typically perform very close to the minimum levels guaranteed by the PBM.

 

By contrast, with a pass-through arrangement, the employer pays the actual contracted discounted pharmacy prices and dispensing fees that the PBM has negotiated with the retail pharmacy network. The guaranteed discount in a pass through proposal should be viewed by the employer as a minimum acceptable performance level, although higher discounts than those guaranteed are often achieved.

ALL PBM TYPES COMPARED

TRADITIONAL PBMs VS OUR
100% PASS-THROUGH PBMs