The Employer's Guide Blog for Overseeing PBMs

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Repackaging: A “Traditional” Pharmacy Benefit Manager’s Black Box Tactic [Video]

Repackaging typically occurs when a company buys a large bottle of a prescription medication such as Lisinopril, and makes it into smaller bottle sizes. So, if a company buys a 1000 count bottle of Lisinopril and simply divides it into 10 bottles of 100, this is repackaging.
The new bottle of 100 is given a new NDC or national drug code and a new price. The new price is at the discretion of the re-packager and most likely higher than the original price. Watch the video below for a detailed illustration.
An even bigger problem (as if the repackaging wasn’t enough) is that most drug pricing for consumer plans are based upon AWP minus a certain percentage. When drugs are purchased, especially through mail order, the payer will not know if the AWP used in the cost formula was derived from an AWP reporting service such as Medispan or newly created as a result of repackaging.
The best means to determine if a medication was repackaged is to compare the NDC from the resulting claim to the manufacturer or distributor NDC. Traditional PBMs will not share this information with you. Fiduciary PBMs such as TransparentRx, LLC, will.

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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