PBM Reimbursement Check
Whether a pharmacy claim was paid what the PBM contract says.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Contract benchmark
- AWP
- Benchmark price per unit
- 5 USD
- Contract percentage
- -18 %
- Dispensing fee
- 1.50 USD
- Quantity
- 30
- Amount paid
- 120 USD
- Acquisition cost per unit
- 4.2 USD
Result: Contract (AWP - 18% + $1.50 fee) pays $124.50 for 30 units; $120.00 was paid: underpaid by $4.50. Against an acquisition cost of $126.00, the claim is underwater by $6.00.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Contract benchmark
- Benchmark price per unit
- Contract percentage (negative for a discount)
- Dispensing fee
- Quantity (units)
- Amount paid (plan plus patient)
- Acquisition cost per unit
How this is calculated
Citation
Arithmetic on the reader's own PBM contract terms and benchmark prices (AWP, WAC, a MAC list, NADAC or acquisition cost), compared with the amount paid and the acquisition cost; no benchmark data are shipped. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.