Has your broker presented a PBM solution that has no Administrative Fee? Or, presented a PBM with a $1 or $2 Administrative Fee and positioned it as competitive?

I’m here to tell you if you’re presented with a PBM that has no Administrative Fee, you are going to want to run the other way!

Wait, what?! Yes, that’s exactly what I meant to say – But why?

Pharmacy Benefit Managers that set their Administrative Fee to $1 or $2 per paid claim for services or, worse yet, completely waive an Administrative Fee are profiting from spread – the difference between what they pay for a drug and what it charges you, the plan sponsor.

They are likely masking a variety of other income streams they’re making from your prescription benefit plan.

So, if you’ve been presented a PBM that carries no Administrative Fee, you should run. If you’re going to stick around for the conversation, you should be asking your broker the following:

-What rebates are the PBM retaining?

-Will the PBM conduct claw backs?

-Will the PBM conduct back-billing?

-What are the dispensing fees?

-And, most importantly, how will these aspects be clearly defined within my PBM contract?

If you’re interested in this concept of transparency and want to learn more, we offer a contract health assessment through our ApexRx program.

If you’re interested in this concept of transparency and want to learn more, I’m happy to share more on the work I do through our ApexRx program. DM me via LinkedIn or slong@apexbg.com.