[marrone12]

That comment does not understand how pharmacies get paid. The patient pay amount is irrelevant to how much the pharmacy makes. Pharmacies make money from prescription dispensing fees, which are generally around 1-2 dollars. PBMs are the ones that make money on patient pay amounts and are the same ones that pay the wholesalers, and they have different payout contracts depending on which card is being used. GoodRx relies on these PBMs for business, who have done the math on the arbitrage being in their favor. Source: I worked at a GoodRX competitor a couple years ago.

[refurb]

I worked with PBMs in the past and it's more than just the dispensing fee.

Typically a pharmacy will enter into a contract with a PBM and the PBM will reimburse the pharmacy for each drug at a set amount. That amount does include a dispensing fee, but the pharmacy can also make money off the margin between acquisition and reimbursement.

So if a months supply costs the pharmacy $30.

The PBM might pay $23 for the drug, $2 dispensing fee and tells the pharmacy to collect a $10 co-pay ($35 total).

Pharmacy makes $5.

However, what I've heard is that it's never that simple. PBMs are constantly trying to pay as close to acquisition cost as possible and when you have multi-source drugs (generics), they often just pay the lowest price.

So I've heard from pharmacies that some drugs have a 50% margin and other have a -20% margin. The PBM tells them it "all evens out" which is BS. The PBMs also have DIR fees, where a couple quarters later they claw back additional money, again arguing that the prior reimbursement was too high. The PBM model is really trying to squeeze pharmacy margins as much as they can.