Every commercial health insurance issuer’s guide for understanding pharmacy benefit managers and medical loss ratio reporting
Recent guidance from the Department of Health and Human Services has provided additional clarity on how issuers should reflect costs for a variety of pharmacy benefit manager (PBM) services, which could have a significant impact on loss ratios for many issuers. This article provides concrete examples of how PBM fees/margin, rebates, and quality improvement activities should be considered for calculating the medical loss ratio under different PBM arrangements.
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Every commercial health insurance issuer’s guide for understanding pharmacy benefit managers and medical loss ratio reporting
This article provides concrete examples of how pharmacy benefit manager (PBM) fees/margin, rebates, and quality improvement activities should be considered for calculating the medical loss ratio under different PBM arrangements.