a. Beneficiary unknowingly subsidizes the pharmacy/PBM
spread by overpaying on drugs that cost less than their copay
b. A prescription costs $2.50 at retail but the member will pay
their $20.00 copay
c. The PBM is allowing the pharmacy to charge the $20.00 copay
and pocket the additional $17.50. In return the pharmacy
agrees to accept lower reimbursement terms (i.e. AWP-15%
while the Client is paying AWP-13%)
d. The PBM pockets the 2% difference that has been subsidized
by the member
