In Reply: Drs Clark and Garis describe what
is commonly referred to as the "spread" on prescription drugs. Employers sometimes
negotiate a rate with the pharmacy benefit manager (PBM) using a discount
to the AWP—eg, 14% off AWP, excluding dispensing fees. At the same time,
the PBM may negotiate a lower rate with the pharmacy—eg, 15% off AWP.
The PBM keeps the spread, or difference. The amounts we report are costs actually
paid by the employer. To the extent there are any discrepancies between what
the PBM and the employer pay, we agree with them that vigilance on the part
of employers—and competition among PBMs—should limit them.
Joyce GF, Goldman DP. Financial Consequences of Drug Benefit Plans. JAMA. 2003;289(4):423–424. doi:10.1001/jama.289.4.423-a
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