Here’s a handy chart we think will be useful as you size up PBM contracts — especially as the 2024 Medicare Part D contracts start to show up. We chose three of the most popular brand drugs and plugged in what the reimbursements look like at AWP minus 25 percent, 30 percent, and 35 percent compared to NADAC (National Average Drug Acquisition Cost) plus a professional dispensing fee.
These charts can also be used to educate lawmakers in Washington on the need to change the pharmacy payment model. It shows how much money you would lose at these hypothetical payment rates on the most popular drugs under Medicare Part D. It’s ugly. Not surprisingly a “cost-plus” payment model is significantly better for the pharmacy and gives plan sponsors predictability and transparency (no spread and a “cost plus” model are features of one of the priority bills at the upcoming NCPA Congressional Pharmacy Fly-in. [Housing deadline for Fly-In is April 3, so don’t delay!]) It’s not shocking to you but it should be to every non-pharmacy owner not used to seeing the daily shakedowns. By all means, please feel free to download it for your own conversations with lawmakers, reporters, your patients, and whomever else will listen.
