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T1DF PBM IBM Payer Manufacturer Map 2017.03.01
T1DF PBM IBM Payer Manufacturer Map 2017.03.01
s
ct
tra
Rebate payment
on
es C
of to
ic e
Reb
s) rn t
pr rvic
ie tu en
or re m
st e
ate
Li & S
nt (& ip
ve s sh
Policy / formulary
Agr
Manufacturer
in ter ct
tio
ss en du
bu
pays % fee to reimbursement optimization
ce c ro
eem
tri
Payment instructions
ex ion p
wholesaler for is
ut ME
D
ent
distribution
rib D
st /
service. Based
di ulin
on wholesale
s
price. In
m
t
se lin
MAC k Agree
Su sh
se
ct
rv p
Service Contract
ic pl ip
Service Fees
a
clau
es y m
ntr
co / Pr en
Co
tt
or
nt im o
ra e Ph
ice
Netw
ct ve ar Payments
rv
(in nd m instructions
ac
Se
ve or
nt C y via IT network at
or on
y t POS
m rac
an t
ag & Reimbursement
DME em
en & Service Fees
Not represented on t)
this graph Pharmacy payment for product Pharmacy Insurer / Payer ACA plan
Actual Acquisition Cost (AAC) = list price subsidies
List price, Plan
Dispense
pays receipt
prescription ACA subsidized
plan participation
m ent and cost data
Reimbursement instructions
Copay or Customer / Insured m pay
miu
Cash flow Coinsurance Pre
payment US GOV
Contractual relationship
Plan summary, EOB
Transfer of drug/DME