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PHARMA INDUSTRY RISK FACTORS
Pricing Source Risk Factors
- Many pricing sources are available
- Each pricing source calculates & reports AWP differently
- Pricing sources allow drug manufacturers to retroactively change prices (sometimes going back 10 years)
- Client may not be aware they are using a highest pricing source
- The PBM uses the pricing sources to create a spread between what they bill the Client and what they pay the pharmacy (pocketing the difference)
- Retroactive price changes may show the PBM being in contract compliance now, when on the date of service, they were not
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