There's a term for what happens when pharmacies are reimbursed below acquisition and dispensing costs of patient prescriptions. It's called " plan subsidizing" - as in, the pharmacy picks up, or "subsidizes" the cost of a prescription the patient's pharmacy benefit manager (PBM) agrees (by contract with the plan payer) to cover.
Plan subsidizing is one of the many reasons PBMs are a $300+ billion per year industry. Pharmacies are forced to absorb the losses while patients and their health plans are none the wiser. It's not a fair business practice, it's anti-competitive and its the reason why pharmacies are closing in record numbers and leaving patients with fewer options to access their medications.
PUTT's Invoice Project is about shifting awareness to the problem of pharmacies subsidizing health plans. We're encouraging pharmacies to invoice plans for prescriptions on which the pharmacy was reimbursed below cost, and copy invoices to PUTT at email@example.com. We're calculating your net losses and will forward aggregate totals to state and federal officials on our pharmacies' behalf.
On this page you'll find editable, downloadable Net Loss Invoices you can complete and send to your plan payors*, including your state health department or Medicaid administrators. Along with instructions for completing the invoices.
We set the dispensing fee on each invoice at $12 - an amount that was determined in a recent study commissioned by NACDS, NASP, and NCPA. To view a copy of the January 2020 Cost of Dispensing Study, click Here.
*Under certain PBM contracts, disclosure of individual Rx reimbursements could be a contract violation. Please consult your plan contracts before sending. For more information contact us at firstname.lastname@example.org.
Editable Excel Spreadsheet Invoice Option
If you like spreadsheets that automatically calculate, download this version, along with instructions for entering your data:
Plan payors need clarification, especially when receiving an invoice they're not expecting. This downloadable cover letter provides clear, concise explanation of billing and is completely editable so you can make it your own.
If you'd like to copy the SBA on your invoicing so they can be made aware of PBM fleecing of small business pharmacies, below is the contact information. Click HERE to access the SBA's website page with regional representative listings. Barbara E. Carson, Deputy Associate Administrator Small Business Administration Office of Government Contracting & Business Development 409 Third St. SW suite 8800 Washington, DC 20416 Phone: 202-205-6460 Fax: 202-205-7324