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This billing practice is known as a “clawback” and you may have no idea it’s happening to your employees or how it impacts your pharmacy costs. Furthermore, pharmacists aren’t allowed to tell patients, under a gag order, that restricts pharmacists from telling patients they are being
overcharged.
These clawback monies are a contributing factor to the unchecked service fees non-fiduciary PBMs rely upon to cover overhead.
Tyrone’s Commentary:
It’s all about the contract.
1) Demand radical transparency
2) Negotiate financial and nonfinancial contracting terms for both direct and indirect revenues
3) Get educated