A GIFT for Brokers & Plan Sponsors Hidden in Prescription Drug Reporting … Maybe

As a Plan Sponsor or Broker, how would you like to see how much your PBM is being paid back from drug manufacturers and also have all details regarding PBM spread amounts?  First off, lets make sure you understand what these things are …

1).  Bona Fide Service Fees

Bona fide service fees are fees that a manufacturer pays to a PBM that:

  • These are services that the manufacturer would otherwise perform (or contract for) in the absence of the service arrangement; and
  • Are not passed on in whole or in part to a client

2).  PBM Spread Amounts

The PBM spread is the difference between the amount the plan, issuer, or carrier paid to the PBM and the amount the PBM paid to manufacturers, wholesalers, pharmacies, or other vendors. For example, if a plan pays $250 to the PBM, and the PBM paid $200 to manufacturers, wholesalers, pharmacies, or other vendors, the PBM spread amount would be $50.

3).  Rebates Retained by the PBM

Manufacturer rebates received by PBMs and not passed through to any member or client.


As you can see, it would be really nice to see exactly what these amounts are.  However, depending upon the way your plan data is reported you will not be able to use the data.  The reason is that one option for reporting is that the PBM can combine all data on all plans in a given state and report in aggregate.  With this approach it is not possible for any specific plan to see their particular data.

It is for this reason we are seeing a lot of brokers in the market look to have their clients report this data on their own, which requires that they obtain only the group specific data from their PBMs.  Also, it is possible that benchmarking could be created around this data as well which would be useful to compare plan sponsors and PBMs.