By Ginny Crisp
Your PBM passes through 100% of manufacturer rebates. The rebate aggregator does not have to.
Most PBM contracts I review do not name the rebate aggregator.
Here is the structure. Manufacturer pays a rebate. The rebate is invoiced through a Group Purchasing Organization, not the PBM directly. The GPO is a separately incorporated entity, often offshore, with a small employee count. The GPO retains a portion of the rebate as a service fee. What the GPO forwards to the PBM is what the PBM “passes through” to your plan.
Three PBMs. Three GPOs. Each PBM’s aggregator shares its corporate parent.
CVS Caremark uses Zinc Health Services. Both under CVS Health.
Express Scripts uses Ascent Health Services. Both under Cigna. Ascent is registered in Switzerland.
OptumRx uses Emisar Pharma Services. Both under UnitedHealth Group. Emisar is registered in Ireland.
The rebate pass-through clause almost always defines pass-through as a percentage of what the PBM receives. Not as a percentage of what the manufacturer paid. The difference between those two definitions is where the aggregator’s fee lives.
Same rebate dollar from the manufacturer. The aggregator keeps a cut. The PBM passes through what is left.
Ask for the GPO’s role in your contract. Ask where the aggregator’s compensation is disclosed. Save this for your next renewal.
