The familiarity of atraditional PBM contracting can create the sense that you know whatyou are actually getting when, in fact, many PBMs work hard to makesure that you don't. (Photo: Shutterstock)
Today, pharmacy benefits managers offer two distinct types ofcontracting as they vie for your client's business: traditional andpass-through. When working on behalf of clients to evaluate PBMs,it is important to understand how these two types of contractingcompare − not just in terms of the numbers calculated for thingslike discounts and rebates, but also in terms of how they functionand align (or fail to align) with your client's interests.
Unexpected differences
For years, the vast majority of PBMs have used a traditionalcontracting approach. This "status quo" approach often includeshidden revenue streams and complex caveats designed to takeadvantage of fee-for-service health care business models. Thisincreases profits for the PBM without regard for the best interestsof plan sponsors−or their members.
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