PBM fees for e-prescribing

[diana.papshev]

Anonymous question from one of our members:

"Our PBM is charging us for electronic prescriptions that are submitted for eligibility reviews and for actual prescriptions. Are other PBMs charging for e-prescriptions? for both services? I thought the prescribers and pharmacies had to pay, but not the payors."

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[chantell.reagan]

Anonymous feedback:

"Yes, I think this is the normal mode of operation. The PBM is charged by a vendor which in turn charges the plan for eligibility, formulary, benefit and drug history inquiries. The prescribers pay nothing (except if they need to pay their EMR vendor to give them this functionality). The pharmacist pays to receive prescriptions electronically. The problem with the picture (from my perspective) is that the plan responsible whether the use is appropriate or not."

[JTTaylor]

Yes, PBM's do pay a transaction fee to Surescripts for each eligibility check.

[coronet601]

It seems odd to me that a PBM would be charging admin fees for accessing SureScripts data. I'd think that these would be part of the comprehensive pricing scheme except for if your plan has specifically agreed to these fees and/or has agreed to sponsor the pharmacies or prescribers fees.