Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
PBM's are not the friend of patients or pharmacies. They tend to limit where patients may get their prescriptions filled and which pharmacy. And if they do not chose the correct pharmacy according to the pbm, they pay a higher copay. Many prescriptions paid by the PBM's are paid to the pharmacy below the cost of the medication, causing the pharmacy to loose money if they chose to fill the prescription. Which is better? Lose the customer or lose money. DIR fees are taken out of the pharmacy payments long after the prescription has been filled and "paid" for by the pbm & patient. So, the pharmacy doesn't really know if there is a profit or not. The pharmacy should be able to know if there is a profit when filling the prescription not weeks later.