PBMs: Traditional vs Fiduciary Repricing Report (Actual)
Express Scripts – Incumbent PBM Total Retail Retail Brand Generic RX COUNT 7,257 2,769 4,488 AWP $809,015.64 $513,092.61 $295,923.03 INGREDIENT COST $587,723.37 $429,827.37 $157,896.00 DISPENSE FEE $8,799.05 $4,065.80 $4,733.25 GROSS COST $596,522.42 $433,893.17 $162,629.25 MEMBER COPAY $50,959.29 $29,030.77 $21,928.52 PLAN COST $545,563.13 $404,862.40 $140,700.73 AVG. DISCOUNT 27.00% 16.00% 47.00% TransparentRx, LLC Total Retail Retail Brand Generic RX COUNT 7,257 2,769 4,488 AWP $809,015.64 $513,092.61 $295,923.03 INGREDIENT COST $517,006.90 $432,483.51 $84,523.38 DISPENSE FEE $17,672.50 $6,712.50 $10,960.00 GROSS COST $534,679.40 439.196.01 $95,483.38 MEMBER COPAY $50,959.29 $29,030.77 $21,928.52 PLAN COST $483,720.11 $410,165.24 $73,554.86 AVG. DISCOUNT 36.00% 16.00% 71.00% PER YEAR NOTE SPREAD SAVINGS $61,843.02 Identified spread (the difference between the PBM pharmacy contract and the PBM plan contract) typically retained by the PBM. REBATES $18,142.50 The average expected Rebate is $2.00 to $3.00 per claim. GENERIC UTILIZATION RATE 62.00% $34,000.00 Estimated savings on four targeted Generic/Therapeutic Switches. MAIL-ORDER DISPENSING RATE 25.00% $29,000.00 Estimated savings when 35% of Rx's dispensed via retail change to our mail-order program. TOTAL SAVINGS $142,985.52 - $36,461.31 PEPM* = $106,524.21 *PEPM or per employee per month fee.