A PBM can charge an employer almost any price for a drug, and it gets paid. In the above table, a PBM billed an employer $188 for bupropion but paid the pharmacy nothing. In that case, the employee copay covered the entire cost of the medication, but the employer got charged an arm and a leg anyway. Similarly, a PBM can set any copay for patients regardless of the medication or the true cost. One patient paid a $285 copay for a $40 medication.1 This is not an extreme case of criminal fraud, it’s perfectly legal. It’s the business model of most of today’s PBMs.
