Follow the Money
PBM economics are shaped by more than the price on the invoice. Definitions, rebates, affiliates, manufacturer payments, spread, and contract exclusions determine where the dollars actually go. Start here and follow the money through the contract.
Three issues to read first.
The Two Words That Do Not Mean What You Think
“Pass-through” and “rebates” sound straightforward. In a PBM agreement, both mean exactly what the contract defines them to mean.
READ THE ISSUE →The Rebate Trap
Rebates can become more than an economic mechanism. Contract terms can turn money the plan believes it earned into leverage that makes changing PBMs harder.
READ THE ISSUE →Plans Negotiate the Price. PBMs Write the Rules.
Employers negotiate discounts, rebates, and guarantees. But the contract definitions and exclusions determine how those promises operate, what revenue can be retained, and whether the negotiated economics can actually be verified.
READ THE ISSUE →Go deeper on incentives, economics, and retained value.
Built to a Different Standard
Contract data reveals how business models show up in the terms governing spread, manufacturer revenue, transparency, and control.
What Good Looks Like
See how transparency, pass-through economics, and fiduciary alignment can be translated into measurable contract standards.
Found a Better Deal? Your Contract Says No.
Economic incentives become more powerful when the contract also restricts the plan’s ability to pursue lower-cost alternatives.
What Does It Cost You To Leave?
Exit economics reveal whether rebates, fees, runout provisions, and data portability preserve your leverage or destroy it.
The Law Changed. The Game Hasn’t.
Changing regulation does not eliminate the need to understand how compensation and incentives move through the system.
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