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This trend has significant implications for Medicare Part D: Medicare Part D Payment Medicare’s payments to Part D sponsors are largely determined through an annual bidding process.

A plan’s bid reflects its estimate of the revenue needed to provide beneficiaries with the Medicare prescription drug benefit.

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Accordingly, it is imperative that health plans and other PBM clients understand PBMs’ rebate labeling games.

Moreover, it is critical that these clients learn how to end all rebate manipulations, since PBMs are siphoning off billions of dollars of clients’ potential savings, and clients aren’t even aware that they are doing so.

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As a result, CMS has observed a growing disparity between gross Part D drug costs, calculated based on costs of drugs at the point-of-sale, and net Part D drug costs, which account for all DIR.If a PBM enters into contracts with drug manufacturers and chooses to give rebates another name — like administrative fees or health management fees or grants — the PBM will arguably eliminate its obligation to pass through the financial benefits to its clients.Moreover, a PBM can deprive its clients of rebates by ensuring the rebates are paid on a basis that is not attributable to the clients’ drug purchases.Medicare Part D – Direct and Indirect Remuneration (DIR) Under Medicare Part D, Medicare makes partially capitated payments to private insurers, also known as Part D sponsors, for delivering prescription drug benefits to Medicare beneficiaries.

Medicare relies on transaction data reported by Part D sponsors to make sure these payments are accurate.

California and federal laws restrict certain disclosures of prescription data.

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