Posted on Apr 28, 2020

CobaltRx

The Tale of Two PBM Pricing Models: Post 4

Both the pass-through and traditional pricing models help manage rising pharmacy plan costs, just in very different ways. We have found that the details in the contract determine the true financial value to the plan sponsor. Overall, we find in the pass-through model, PBMs offer less aggressive discounts and rebates yet are more flexible and allow for plan customization and outside programs to integrate with theirs to offer additional pharmacy plan management. We find that the traditional model does drive more aggressive discounts and higher rebates. However, unlike the pass-through model, they allow very little plan customization or outside programs that conflict with their formulary and use of drugs that drive higher rebate dollars. Traditional plan contracts may also have language that excludes many claims from discount guarantees and from qualifying for rebates.

Cont'd on Post 5...
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