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How do PBMs make money?
  PBMs make money in three ways: 1) Administering the prescription benefit portion of health plans, including processing and paying the claims of plan participants 2) Profits from the prescription drugs that their mail-order divisions sell 3) Rebates from drug manufacturers
 
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Coalition for Quality Healthcare

"Upholding high standards of personal service, assuring full access to
consumer options and preserving the traditional contributions of local
pharmacies to the state's economy"

© Copyright 2004 Coalition for Quality Healthcare. All rights reserved.

 

 
1. What is the Coalition for Quality Healthcare?
2. What does the Coalition hope to accomplish?
3. What is a “pharmacy benefit manager,” or “PBM?”
4. How do PBMs make money?
5. What’s wrong with the way PBMs currently operate?
6. Why should consumers care about mandatory mail-order prescriptions?
7. Won’t forcing PBMs to give local pharmacies the same financial terms they give their own mail-order units raise healthcare expenses for businesses?
8. Filling prescriptions by mail order seems like a great idea. Why are local pharmacies against it?
9. Instead of complaining about the special deals that mail-order companies make with PBMs, why don’t local pharmacies make their own deals with the PBMs?
10. If pharmacies could fill 90-day prescriptions for just one co-pay, would businesses save just as much as through mail order?
11. Can’t I just tell my pharmacist which maintenance drugs I receive through mail order, so that he/she is aware of possible drug interaction or overlap problems?
12. What else is sacrificed when drugs are ordered by mail?
13. Explain the rebate and discount system that exists between PBMs, drug manufacturers and mail-order companies? How are pharmacies hurt by that system?
14. How could the loss of that business affect some drugstores?
15. What would be the wider impact of that development?
16. What portion of local pharmacy revenues are comprised of maintenance drugs?
17. Where does the Coalition for Quality Healthcare get its funding?
18. How much does the Coalition for Quality Healthcare spend on administration?