PBM Insider

The Definition of Oversee: to watch over and direct (an undertaking, a group of workers, etc.) in order to ensure a satisfactory outcome or performance.

The Employer’s Guide Blog for Overseeing PBMs

PBMs: Traditional vs Fiduciary Repricing Report (Actual)

Express Scripts – Incumbent PBM
TotalRetailRetail
BrandGeneric



RX COUNT7,2572,7694,488
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. DISCOUNT27.00%16.00%47.00%
TransparentRx, LLC
TotalRetailRetail
BrandGeneric



RX COUNT7,2572,7694,488
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$534,679.40439.196.01$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. DISCOUNT36.00%16.00%71.00%
PER YEARNOTE
SPREAD SAVINGS$61,843.02Identified spread (the difference between the PBM pharmacy contract and the PBM plan contract) typically retained by the PBM.
REBATES$18,142.50The average expected Rebate is $2.00 to $3.00 per claim.
GENERIC UTILIZATION RATE62.00%$34,000.00Estimated savings on four targeted Generic/Therapeutic Switches.
MAIL-ORDER DISPENSING RATE25.00%$29,000.00Estimated 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.

Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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