TIER 2 · PBM COMPENSATION · AUDIT WORKSHEET
Five Revenue Streams Flow from Your Plan to Your PBM.
Most Plan Sponsors Track One. The Worksheet Maps All Five.
A 2-page printable worksheet PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
Three audit passes across five compensation mechanisms
Spread, rebate retention, admin fees, owned-pharmacy margin, manufacturer fees
The comprehensive view single-stream audits miss
One contract, five places the money moves
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
See the Whole Picture
Three passes walk each stream: what the contract permits, what the report discloses, and what an independent audit would find. The gaps between the three are the compensation hiding in plain sight.
PASS 01
Map Five Revenue Streams
Your PBM earns from your plan five ways: pricing spread, retained rebates, administrative fees, margin on its owned pharmacies, and manufacturer-paid fees. Most plan sponsors track only one.
PASS 02
Audit Each Mechanism
Three passes walk each stream: what the contract permits, what the report discloses, and what an independent audit would find. The gaps between the three are the compensation hiding in plain sight.
ACTION PLAN
This Quarter's Action Plan
Run the five-stream audit, total the documented compensation, and require disclosure of every stream in the next contract. You cannot negotiate a number you have never been allowed to see.