ScriptSourcing, LLC

ScriptSourcing, LLC ScriptSourcing helps prevent, mitigate, and transfer risk to create high-performing health plans.

What Are Audit Rights? 📋Audit rights are the contractual ability for a plan sponsor to review pharmacy claims, pricing, ...
12/14/2025

What Are Audit Rights? 📋
Audit rights are the contractual ability for a plan sponsor to review pharmacy claims, pricing, and PBM practices. When those rights look good on paper but you can’t actually get detailed data, real oversight and savings never materialize.

Why Does It Matter? 💵
When audit rights are “look-but-don’t-touch”:
💸 Employers may be blocked from seeing claim-level or network-level details.
🤝 Key pricing inputs and rebate flows can stay hidden behind vague summaries.
🚦 Errors, overpayments, and spread pricing can go undetected year after year.

The Illusion of Oversight 🕹️
With limited access:
🔍 You might get reports, but not the raw data needed to verify them.
🏦 PBMs can design terms that appear transparent while keeping the real levers opaque.
📈 Plans absorb higher costs, even though the contract technically “allows” audits.

Bottom line: 🧠
Audit rights without access are just rights on paper—no leverage, no validation, and no way to truly protect the plan or its members.

What’s a True-Up? ⚖️A “true-up” is the reconciliation process PBMs use to compare promised contract terms (like rebates ...
12/13/2025

What’s a True-Up? ⚖️
A “true-up” is the reconciliation process PBMs use to compare promised contract terms (like rebates or guaranteed discounts) with actual performance results. In theory, it ensures everything balances at the end of a period. In reality, it’s often where definitions—and dollars—get quietly adjusted.

Why Does It Matter? 💵
When true-ups lack transparency:
💸 PBMs can selectively define what counts as “savings.”
🧾 Employers have to trust data they can’t verify.
📉 A favorable recalculation for the PBM can become an unnoticed overcharge for the plan.

The Hidden Adjustment Game 🕹️
Here’s how the margin rounding happens:
🔍 The PBM controls both the math and the audit window.
🏦 Any “shortfall” gets settled on their terms, not yours.
🤐 Without clear definitions, reconciliation becomes reinvention—and employers pay the difference.

Bottom line: 🧠
A true-up should true things up, not tilt them. Without full visibility into every calculation, the only thing getting rounded up is the PBM’s margin.

What’s Rebate Math? 📋Rebate math is how PBMs and manufacturers calculate, apply, and share rebate dollars tied to specif...
12/13/2025

What’s Rebate Math? 📋
Rebate math is how PBMs and manufacturers calculate, apply, and share rebate dollars tied to specific drugs on a formulary. When that math is complex and opaque, it can distort prices and hide what plans and members are really paying at the pharmacy counter.

Why Does It Matter? 💵
When rebates drive the strategy:
💸 High rebate, higher-cost brands can be favored over truly low-cost generics.
🤝 “Savings” are often measured on paper, not at the point of sale for members.
🚦 Employers may celebrate big rebate checks while their actual drug spend quietly climbs.

The Hidden Inflation Game 🕹️
With rebate-heavy designs:
🔍 List prices can rise while net prices and rebate deals stay hidden from view.
🏦 PBMs and manufacturers can benefit financially from higher list prices and bigger rebate pools.
📈 Generic inflation and overall trend can be masked by glossy reports that focus on rebate totals, not true net cost.

Bottom line: 🧠
Generic inflation hides behind rebate math when the focus is on chasing rebates instead of lowering the real price of drugs for plans and members.

What Is Rebate Aggregation? 💊Rebate aggregation happens when a PBM or rebate aggregator pools manufacturer rebates acros...
12/12/2025

What Is Rebate Aggregation? 💊
Rebate aggregation happens when a PBM or rebate aggregator pools manufacturer rebates across multiple clients before redistributing them. Sounds efficient—but this process often dilutes what each plan actually receives, leaving employers guessing what portion of their money made it back.

Why Does It Matter? 💵
When rebates get pooled:
💸 Your plan’s savings blend into someone else’s balance sheet.
🤝 The PBM or aggregator controls all the tracking, timing, and definitions.
🕳️ Employers lose visibility into true rebate value—and where it really lands.

The Profit in Dilution 🧮
Here’s what happens behind closed spreadsheets:
🔍 Aggregation allows markups and “administrative holds” before redistribution.
🏦 PBMs can earn float, fees, or spread on rebate dollars you funded.
📉 Transparency disappears as rebates pass through multiple “processing” layers.

Bottom line: 🧠
Rebate aggregation doesn’t protect value—it fragments it. When rebates are diluted across clients, the only consistently full share is the PBM’s.

What’s Claim Logic? 🧠Claim logic is the behind-the-scenes rules that decide how a prescription claim is priced, paid, an...
12/12/2025

What’s Claim Logic? 🧠
Claim logic is the behind-the-scenes rules that decide how a prescription claim is priced, paid, and split between the plan and the member. When those rules are kept secret, it’s nearly impossible for employers to see where the money is really going—or why certain drugs cost what they do.

Why Does It Matter? 💵
When claim logic is “black box”:
💸 Hidden markups and spreads can be baked into the math.
🤝 Pricing rules can quietly favor higher-cost drugs or certain pharmacies.
🚦 Plan sponsors and members may pay more, without any clear explanation.

The Hidden Math Game 🧮
With confidential claim logic:
🔍 You can’t easily verify if discounts, rebates, and fees are passed through.
🏦 Intermediaries can design formulas to boost their margins, not your savings.
📈 Employers may see rising pharmacy spend while the true drivers stay buried.

Bottom line: 🔓
When the claim logic is confidential, the profits aren’t accidental—they’re engineered by whoever controls the math.

What Are Contract Clauses in PBM Agreements? 📑Contract clauses are the fine-print details that govern how your PBM relat...
12/11/2025

What Are Contract Clauses in PBM Agreements? 📑
Contract clauses are the fine-print details that govern how your PBM relationship operates—everything from pricing definitions and guarantees to audit rights and termination terms. They’re designed to sound protective, but many are actually engineered to preserve PBM profits, not employer control.

Why Does It Matter? 💵
When clauses are written to protect margins:
⚖️ “Safeguards” can double as profit shields.
🚫 Escape or audit limitations restrict your ability to hold vendors accountable.
💸 Even well-intended provisions—like guarantees—often exclude the biggest cost drivers.

The Profit Trap in Plain Sight 🪤
Here’s how protection turns into profit:
🔍 Definitions and exceptions favor the PBM’s data, not yours.
📁 Renewal and performance language can quietly lock in higher costs.
🏦 The more complex the clause, the more margin room it hides.

Bottom line: 🧠
Every line in a PBM contract deserves scrutiny. What looks like a safeguard could be a mechanism to secure their margins—not your savings.

12/11/2025

Moving from fully insured to self-funded opens a lot of doors — fewer restrictions, more flexibility, and greater control.

Danny Rosenfield shares how understanding point solutions is key to making a self-funded plan work the way it’s designed to.

🎧 Listen to his full episode on Spotify now!

What Are Contract Definitions? 📋Contract definitions are the fine-print terms that explain how drugs are categorized, pr...
12/11/2025

What Are Contract Definitions? 📋
Contract definitions are the fine-print terms that explain how drugs are categorized, priced, and paid within your PBM agreement. When those definitions are vague or hidden in dense language, it becomes extremely hard for employers to track where their pharmacy dollars are actually going.

Why Does It Matter? 💵
When definitions are loose or buried:
💸 PBMs can quietly reclassify drugs or fees in ways that increase their margins.
🤝 Key terms like “brand,” “generic,” or “specialty” can shift without the plan realizing it.
🚦 Employers may approve one deal on paper but end up paying for something very different in practice.

The Fine-Print Profit Game 🕹️
With buried definitions:
🔍 The real pricing rules live in footnotes, exhibits, and opaque glossary sections.
🏦 Small wording changes can open big loopholes for extra spread, fees, and exclusions.
📈 Plan sponsors and members absorb higher costs, while the contract still looks “competitive.”

Bottom line: 🧠
If the definitions are buried, so are the dollars—hidden language hides real money, and it usually doesn’t hide in the employer’s favor.

What Are Discount Rates in PBM Contracts? 💸Discount rates are the percentages PBMs use to show how much they “reduce” dr...
12/10/2025

What Are Discount Rates in PBM Contracts? 💸
Discount rates are the percentages PBMs use to show how much they “reduce” drug costs off a benchmark price, like AWP (Average Wholesale Price). On paper, the deeper the discount, the more it looks like savings—but the real story depends entirely on how those terms are written.

Why Does It Matter? 💵
When discount rates look better than they are:
📊 PBMs define which drugs count toward “discounted” categories.
🔍 Benchmarks like AWP are inflated or outdated.
🏦 Employers see big-sounding discounts—but miss the hidden markups behind them.

The Math Behind the Marketing 📑
Here’s how the illusion forms:
🧮 PBMs negotiate discounts that apply to selective claims, not your total spend.
🤝 Contract language hides different rates for mail-order, specialty, or retail.
💰 A “great” discount on paper simply offsets a price inflated in the first place.

Bottom line: 🧠
A discount only counts when it reduces a true cost—not a manipulated benchmark. Favorable wording doesn’t equal favorable economics.

Saving money on prescriptions just got easier with our dedicated member advocates by your side! 💊✨
12/10/2025

Saving money on prescriptions just got easier with our dedicated member advocates by your side! 💊✨

12/10/2025

Sales and discounts sound great — but if you don’t know the real price, do they even matter? 💡

In this episode, Allison De Paoli breaks down why transparency in healthcare pricing is essential and why the ‘discount’ story doesn’t always add up.

🎧 Listen to her full episode on Spotify now!

What Are Opaque Contracts? 🕶️An opaque contract hides key details—definitions, pricing formulas, and fee structures—unde...
12/10/2025

What Are Opaque Contracts? 🕶️
An opaque contract hides key details—definitions, pricing formulas, and fee structures—under complex or confidential language. In PBM agreements, opacity isn’t accidental; it’s strategic. The less you can see, the more they can shape outcomes behind the scenes.

Why Does It Matter? 💵
When contracts lack clarity:
📑 Employers can’t trace where every dollar goes.
💸 “Guaranteed savings” become unverifiable promises.
🤐 Questions about pricing or rebates get deflected under “proprietary” protections.

The Cost of Staying in the Dark 💡
Here’s how opacity translates to expense:
🔍 Unclear language lets PBMs define metrics and margins to their advantage.
🏦 Plan sponsors lose leverage in audits, renewals, and renegotiations.
📉 The result: predictably unpredictable costs—and profits you can’t track.

Bottom line: 🧠
Opaque contracts create opaque results. The only way to reclaim control is through fearless transparency—because clarity doesn’t just expose profit, it restores power.

Address

3301 Bonita Beach Road Suite 106
Bonita Springs, MD
34134

Opening Hours

Monday 8:30am - 5:30pm
Tuesday 8:30am - 5:30pm
Wednesday 8:30am - 5:30pm
Thursday 8:30am - 5:30pm
Friday 8:30am - 5:30pm

Telephone

+14109028811

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