PPM Exam 2

Card Set Information

Author:
Rx2013
ID:
141782
Filename:
PPM Exam 2
Updated:
2012-03-15 13:48:13
Tags:
PBM
Folders:

Description:
PBM
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  1. Definition of PBM
    • middle man to contract with corporations and sell them a drug at a certain rate
    • also contract with pharmacy for buying price
  2. ___% of income for pharmacies is paid through a PBM
    90%
  3. Early role of PBMs
    process Rx claims electronically
  4. Transparent model
    • no hidden revenue sources for PBM
    • some spread remains
    • revenue sources identified but not exact revenue
    • Admin fee in the form of % AWP
  5. Pass-through model
    • no hidden revenue sources
    • no spread
    • revenue from admin fee
    • sponsor pays what pharmacy is reimbursed
    • true transparent model
  6. The difference between what the PBM pays the pharmacy and charges the sponsor
    spread
  7. Predictive model
    PBM provides average of at least 2 years of data to sponsor to project future spending

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