SIOUX FALLS, S.D., May 18 /PRNewswire/ -- Retail pharmacies are unjustly targeted as being a source of rising healthcare costs. In reality a greater threat to controlling costs are the tactics that lead to hidden revenue streams generated by many large PBMs. After researching proper contracting methods to protect the payer, AmeriPharm has identified another tactic some PBMs deploy to generate substantial revenue. The amount a PBM charges the payer for drug ingredient cost plus the dispensing fee, versus the amount reimbursed to network pharmacies is referred to as SPREAD. Examples of PBM contracted discount rates and resulting SPREADS are as follows:
Contracts Brand Generic MAC PBM / Retail Pharmacy Negotiated Discount AWP -16% AWP -40% AWP -70% PBM / Client Contract Reimbursement Price AWP -14% AWP -30% AWP -30% PBM captured SPREAD on drug ingredient expenditure 2% 10% 40%
Payers must take an active role in understanding and protecting against unnecessary and hidden PBM charges. Two necessary questions that should be asked of the PBM administrator are:
1 - Is there a SPREAD between the amount you charge us and the amount you reimburse your network pharmacies? 2 - Do you apply the same Maximum Allowable Cost (MAC) to your own mail order pharmacy as you do to the retail network?
When opportunity arises to contract with a PBM partner or select a mail order pharmacy, choose a partner that promotes full disclosure, transparency, and fiduciary responsibility to clients and managed care organizations. The payer should insist on the opportunity to conduct a full audit with detailed reporting on information related to their book of business.
About AmeriPharm
AmeriPharm is a national provider of mail order pharmacy and other health care related services based in Sioux Falls, South Dakota. Formed in 2003, the company's focus is to exemplify an environment of full disclosure and transparency in pharmacy healthcare management by collaborating with PBMs, managed care organizations, and payers who share the same philosophies. Find more information about AmeriPharm at http://www.ameripharminc.com/ .
Contact: Mr. Dennis Olsen AmeriPharm, Inc. Work Phone: (605) 978-3980 Fax: (605) 978-3999 dennis.olsen@ameripharminc.comhttp://www.ameripharminc.com/
AmeriPharm, Inc.CONTACT: Mr. Dennis Olsen of AmeriPharm, Inc., +1-605-978-3980,fax, +1-605-978-3999, dennis.olsen@ameripharminc.com
Web site: http://www.ameripharminc.com/
