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Understanding Employer Evaluation of Pharmacy Benefit Managers

Explore the key points employers consider in evaluating Pharmacy Benefit Managers (PBMs), including AWP discounts, dispensing fees, administrative fees, rebates, MAC spreads, and more. Uncover the nuances of pharmacy pricing and the impact on employer costs and decisions.

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Understanding Employer Evaluation of Pharmacy Benefit Managers

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Presentation Transcript

  1. Typical PBM Evaluation Points (from the employer’s point of view)

  2. Typical PBM Evaluation Points (from the employer’s point of view) • AWP Discounts (brand) • Dispensing Fees • Administrative Fees • Rebates

  3. What’s under the surface?

  4. Pharmacy (MAC) Spreads • Net Effective AWP Rates • Pre & Post Rollback Pricing • Rebate Guarantees • Higher Cost Preferred Drugs • Mandatory Mail Order • Specialty Drugs • Multisource Brand Pricing • 9-Digit NDC Pricing • Rebate Filing Fees

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