Who Gets The Clawback Money?

By Molley Mulebriar

“This nightmare scenario is something that’s been happening to more and more pharmacies over the past few years. It’s part of a widely reviled practice called “clawbacks” — fees, often totally unpredictable, that PBMs charge pharmacies to “claw back” some of the money they’ve already paid them in reimbursements.”

Plan sponsors self-funding their employee health & welfare plan may be wondering who’s getting the clawback money?

Shouldn’t the plan sponsor get those clawback dollars? After all, it was their money in the first place? This has got to be the biggest scam since Victor Lustig sold the Eiffel Tower.

Could this practice be no different than the case of a third party intermediary recouping  plan assets (money) back from a hospital due to an “over payment” and keeping it, a practice commonly called a “shared savings” arrangement?

 

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