Pharmacy rebate value calculator: how much comes back to your plan?
Enter annual pharmacy spend, the brand share, the rebate rate and the share passed back to estimate the value of rebates. Built for self-funded employers reviewing a pharmacy benefit contract.
Estimate the value of pharmacy rebates.
The rates are your assumptions until you see the contract. The result updates as you type.
Your assumption. Ask the PBM for actual rates.
Set by your PBM contract.
Your estimate
An illustration from your own assumptions, not a contract term. Actual results depend on drug mix, formulary and the PBM agreement.
What is a pharmacy rebate?
Drug makers pay rebates to pharmacy benefit managers in exchange for favorable placement on a formulary. The PBM may keep part and pass the rest to the plan sponsor. The amount depends on the drugs used, the formulary and the contract. For a self-funded employer, the share passed back can be a meaningful offset to drug cost.
What should an employer look for in a contract?
Look at how rebates are defined, whether the guarantee is per prescription or a percentage, how much is passed back and when, and whether other revenue such as spread or administrative fees is disclosed. Audit rights let an employer check that the plan received what the contract promised. A broker or consultant can help review the terms.
Common questions
Do fully insured plans receive rebates directly?
Generally no. The carrier builds pharmacy cost, including rebates, into the premium. Rebate pass-back is mostly a feature of self-funded and some level-funded contracts.
What is spread pricing?
It is a difference between what a PBM charges the plan and what it pays the pharmacy. Ask whether your contract allows it.
Are rebates guaranteed?
Some contracts include a guarantee. Others pass back what is received. Read the terms and ask for reporting.
Who can review our PBM contract?
We can compare contract terms and model the effect of different rebate structures with you.
Talk to us about pharmacy cost
Book a 30-minute call and we will look at your pharmacy spend, your contract and the options that fit. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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