[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.