Tuesday, October 9, 2012

PBMs: Traditional vs Fiduciary Repricing Report (Actual)



Express Scripts – Incumbent PBM

Total Retail Retail


Brand Generic




RX COUNT 7,257 2,769 4,488
AWP $809,015.64 $513,092.61 $295,923.03
INGREDIENT COST $587,723.37 $429,827.37 $157,896.00
DISPENSE FEE $8,799.05 $4,065.80 $4,733.25
GROSS COST $596,522.42 $433,893.17 $162,629.25
MEMBER COPAY $50,959.29 $29,030.77 $21,928.52
PLAN COST $545,563.13 $404,862.40 $140,700.73
AVG. DISCOUNT 27.00% 16.00% 47.00%





TransparentRx, LLC

Total Retail Retail


Brand Generic




RX COUNT 7,257 2,769 4,488
AWP $809,015.64 $513,092.61 $295,923.03
INGREDIENT COST $517,006.90 $432,483.51 $84,523.38
DISPENSE FEE $17,672.50 $6,712.50 $10,960.00
GROSS COST $534,679.40 439.196.01 $95,483.38
MEMBER COPAY $50,959.29 $29,030.77 $21,928.52
PLAN COST $483,720.11 $410,165.24 $73,554.86
AVG. DISCOUNT 36.00% 16.00% 71.00%





PER YEAR NOTE
SPREAD SAVINGS $61,843.02 Identified spread (the difference between the PBM pharmacy contract and the PBM plan contract) typically retained by the PBM.




REBATES $18,142.50 The average expected Rebate is $2.00 to $3.00 per claim.




GENERIC UTILIZATION RATE 62.00% $34,000.00 Estimated savings on four targeted Generic/Therapeutic Switches.




MAIL-ORDER DISPENSING RATE 25.00% $29,000.00 Estimated savings when 35% of Rx's dispensed via retail change to our mail-order program.




TOTAL SAVINGS $142,985.52 - $36,461.31 PEPM* = $106,524.21




*PEPM or per employee per month fee.


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