ScriptSourcing, LLC

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

What’s a U&C Game? 🎯“U&C” stands for Usual and Customary—the benchmark pharmacies use to define a drug’s standard retail...
12/21/2025

What’s a U&C Game? 🎯
“U&C” stands for Usual and Customary—the benchmark pharmacies use to define a drug’s standard retail price. PBMs rely on this number to calculate reimbursement and discounts, but when that benchmark shifts, so do the dollars behind it.

Why Does It Matter? 💵
When U&C becomes “move-to-profit”:
💰 PBMs can manipulate definitions to influence what counts as the true “usual” price.
🏪 Some pharmacies inflate or suppress pricing data to fit PBM contract terms.
📉 Plans and members may not realize their benchmark has changed—and their costs with it.

The Hidden Pricing Game 🕹️
With U&C manipulation:
🔍 Payment accuracy takes a back seat to strategic pricing.
🏦 PBMs and select partners gain flexibility to capture margin in the shadows.
📈 Employers and members foot the bill for numbers they can’t see or verify.

Bottom line: 🧠
When PBMs control the benchmark, they control the payout—and that means who wins and who pays can quietly change overnight.

What Does “Complexity” in PBM Contracts Mean? 🔄PBM contracts are often packed with layered terms, shifting benchmarks, a...
12/20/2025

What Does “Complexity” in PBM Contracts Mean? 🔄
PBM contracts are often packed with layered terms, shifting benchmarks, and conditional guarantees. They’re written to sound protective—but too much complexity usually hides one simple truth: whoever controls the definitions controls the dollars.

Why Does It Matter? 💵
When complexity becomes the goal:
🌀 Every clause invites interpretation that benefits the PBM.
💸 Savings get buried under a maze of fee categories and definitions.
🤔 Employers can’t easily verify what they’re paying—or why.

The Profit Behind the Puzzle 🧩
Here’s how complexity works to their advantage:
🔍 Layered guarantees and undefined metrics create “wiggle room.”
📑 Cross-referenced clauses make it nearly impossible to trace real unit costs.
📈 The PBM gains flexibility in reporting, while employers lose control of clarity.

Bottom line: 🧠
When a contract’s design feels too intricate to decode, it usually means it’s working exactly as intended—to protect margin, not transparency.

What’s a Mail-Order Mandate? 📦A mail-order mandate is when a PBM requires certain prescriptions—often maintenance or spe...
12/20/2025

What’s a Mail-Order Mandate? 📦
A mail-order mandate is when a PBM requires certain prescriptions—often maintenance or specialty drugs—to be filled through their own mail-order pharmacy. It’s pitched as convenience for the member, but the real benefit often lands with the PBM.

Why Does It Matter? 💵
When mandates are “mandatory for profit”:
🏦 PBMs capture added dispensing fees through their owned pharmacies.
💊 Members lose the freedom to choose their preferred local pharmacy.
🚗 Employers and plans may see inflated costs wrapped in the promise of “efficiency.”

The Hidden Fulfillment Game 🕹️
With mail-order mandates:
🔁 The line between patient care and corporate control blurs.
📦 Local pharmacy relationships disappear, replaced with centralized profit hubs.
📈 PBMs grow margins, while real savings for plans and members often shrink.

Bottom line: 🧠
When “choice” is replaced by “requirement,” the convenience isn’t for the member—it’s for the PBM’s bottom line.

What Does “Negotiation” Really Mean? 🤝Every PBM contract is presented as a negotiation—a back-and-forth to secure “the b...
12/19/2025

What Does “Negotiation” Really Mean? 🤝
Every PBM contract is presented as a negotiation—a back-and-forth to secure “the best deal.” But real negotiation only works when both sides have equal visibility into the numbers. Without clear cost data and definitions, negotiation becomes performance theater—one party acts informed; the other profits.

Why Does It Matter? 💵
When the math is missing:
📊 Employers negotiate perceptions, not proof.
💸 “Savings” are measured against numbers the PBM controls.
🤐 Terms like “competitive pricing” mean little without validated transparency.

The Hidden Cost of Blind Bargaining 💼
Here’s how the imbalance works:
🔍 PBMs present averages, not actuals—keeping granular cost data off the table.
🏦 Price models built on partial math always protect margin, not savings.
📉 Employers feel confident at signing but lose leverage after the contract starts.

Bottom line: 🧠
Negotiation without math isn’t negotiation—it’s acceptance. If you can’t see the data behind the deal, you’re not negotiating value; you’re approving margin.

What’s Specialty Channel Steering? 🚚Specialty channel steering happens when PBMs require high-cost medications to be fil...
12/19/2025

What’s Specialty Channel Steering? 🚚
Specialty channel steering happens when PBMs require high-cost medications to be filled through their own or preferred specialty pharmacies. This redirection limits choice for members and employers—often locking them into higher-priced channels.

Why Does It Matter? 💵
When steering is “by design”:
🏦 PBMs profit from dispensing drugs through their own pharmacies.
🎯 Members lose the option to choose where their prescriptions are filled.
💸 Employers and health plans foot the bill for inflated pharmacy markup.

The Hidden Control Play 🕹️
With specialty steering:
🔄 Independent and cost-effective pharmacy options are pushed aside.
📦 Patients face delays or hassles in getting their prescriptions.
🚨 PBMs hold both the pen and the profit, directing care for their own gain.

Bottom line: 🧠
When PBMs steer prescriptions to their own channels, it limits competition, raises costs, and puts profit over patient convenience.

What Does PBM “Complexity” Really Mean? 🧩PBMs often describe their pricing models, rebate structures, and performance gu...
12/18/2025

What Does PBM “Complexity” Really Mean? 🧩
PBMs often describe their pricing models, rebate structures, and performance guarantees as “complex.” But complexity usually isn’t a necessity—it’s a design choice. The more complicated the contract, the easier it becomes to hide how profits are made and where dollars disappear.

Why Does It Matter? 💵
When complexity replaces clarity:
📑 Employers lose the ability to verify true savings.
💸 Layers of terms and metrics disguise margin mechanics.
🤐 Confusion becomes a strategy—and the PBM’s strongest shield.

The Camouflage Effect 🕵️‍♂️
Here’s how complexity hides profit:
🔍 Ambiguous terms let PBMs interpret outcomes however they choose.
🏦 Multi-step rebate and fee flows bury actual cost drivers.
📉 Employers end up relying on summaries instead of full transparency.

Bottom line: 🧠
If a PBM says “it’s complicated,” it probably means “it’s profitable.” Simplicity isn’t the enemy—it’s the enemy of hidden revenue.

What Does “If You Can’t See the Price” Mean? 💰In PBM contracts, visibility is power. When employers can’t see how drug p...
12/18/2025

What Does “If You Can’t See the Price” Mean? 💰
In PBM contracts, visibility is power. When employers can’t see how drug prices are determined—what’s billed, what’s rebated, and what’s retained—they lose control of the deal. Behind every “confidential” price point is a margin the PBM doesn’t want you to find.

Why Does It Matter? 💵
When pricing isn’t transparent:
📉 Employers can’t confirm whether discounts or rebates reach the plan.
💸 PBMs profit from spreads and rebates that never get disclosed.
🤐 Lack of visibility turns the buyer into the product being sold.

The Price of Secrecy 🔒
Here’s how opacity plays out:
🔍 PBMs hide wholesale and acquisition costs behind proprietary formulas.
🏦 “Confidential” pricing becomes a source of recurring profit, not plan savings.
📊 The result—plans fund PBM revenue streams they’ll never see on a spreadsheet.

Bottom line: 🧠
If you don’t know the true cost, you’re not controlling the deal—you’re fueling it. Transparency isn’t just nice to have; it’s the only safeguard against becoming the profit source.

What Are PBM Audits? 🔍Audits allow employers to verify whether their PBM is honoring contract terms—checking everything ...
12/17/2025

What Are PBM Audits? 🔍
Audits allow employers to verify whether their PBM is honoring contract terms—checking everything from rebate flow and pricing accuracy to fee application and claim adjudication. A transparent PBM welcomes audits because they confirm trust. A defensive one? That’s where red flags start waving.

Why Does It Matter? 💵
When a PBM resists auditing:
📑 They may restrict audit scope or limit third-party access.
💸 Key financial data—like true rebate amounts or claim-level pricing—stays hidden.
🤐 The less you’re allowed to review, the more likely something isn’t adding up.

The Trust Test ⚖️
Here’s how audit behavior reveals intent:
🔍 True partners collaborate; profit-driven ones complicate.
🏦 Resistance to independent review usually means margin protection.
📉 Without full audit rights, “transparency” becomes a controlled narrative, not a fact check.

Bottom line: 🧠
Audits aren’t an attack—they’re accountability. Any partner who discourages scrutiny isn’t preserving efficiency; they’re preserving profit.

When it comes to prescription savings, our member advocates are the experts you can trust. 🏆
12/17/2025

When it comes to prescription savings, our member advocates are the experts you can trust. 🏆

What Does “Industry Standard” Really Mean? 🏷️PBMs often justify vague or restrictive contract terms as industry standard...
12/17/2025

What Does “Industry Standard” Really Mean? 🏷️
PBMs often justify vague or restrictive contract terms as industry standards. It's a phrase meant to sound reassuring—but in practice, it often reflects habits created to protect profits, not plan sponsors. Every norm started somewhere, usually where a loophole proved lucrative.

Why Does It Matter? 💵
When “standard” becomes an excuse:
📑 Clauses like “proprietary data” or “aggregate reporting” limit employer oversight.
💸 Historical practices hide outdated or one-sided pricing mechanisms.
🤐 The term “standard” makes pushback sound unreasonable—when it’s anything but.

The Loophole Legacy 🧩
Here’s how these standards evolve:
🔍 One PBM introduces a clause that boosts margin.
🏦 Competitors copy it under the banner of “best practice.”
📈 It becomes so common, employers stop questioning it—and profits stay protected.

Bottom line: 🧠
Just because it’s standard doesn’t mean it’s fair. True leadership means questioning the norms that quietly cost your plan money.

What Does “Disappearing Data” Mean? 📂In a PBM contract, data access determines how much insight employers have into clai...
12/16/2025

What Does “Disappearing Data” Mean? 📂
In a PBM contract, data access determines how much insight employers have into claims, rebates, and performance outcomes. When certain reports, fields, or audit files go “missing,” it’s rarely accidental. Limited access gives PBMs more control—and leverage—over the financial story your plan sees.

Why Does It Matter? 💵
When data disappears:
📉 Employers can’t validate costs, rebates, or contract compliance.
🤐 PBMs define results without exposure to independent verification.
💸 Incomplete data means incomplete accountability.

How Hidden Data Becomes Hidden Margin 🏦
Here’s how disappearance turns into leverage:
🔍 Missing fields can hide pricing details tied to spread or rebates.
📁 PBMs restrict data export or require “approved vendors” to review it.
📈 With partial visibility, profit can be redirected unseen—and unchallenged.

Bottom line: 🧠
Data gives you power only if you can access it. When visibility is restricted, the PBM isn’t protecting privacy—they’re protecting profit.

What Are Network Differentials? 🌐Network differentials are hidden price variations built into a PBM’s pharmacy network. ...
12/16/2025

What Are Network Differentials? 🌐
Network differentials are hidden price variations built into a PBM’s pharmacy network. Even when pharmacies seem “in-network,” the rates PBMs pay versus what they charge the plan can differ—creating quiet profit on every transaction.

Why Does It Matter? 💵
When differentials are “by design”:
🏪 Two pharmacies could dispense the same drug at dramatically different reimbursements.
💰 PBMs pocket the spread between what they pay and what they bill.
🔒 Employers believe they’re accessing competitive pricing—without seeing the hidden markup.

The Hidden Toll Game 🕹️
With network differentials:
🔍 Transparency vanishes behind complex contract language.
🏦 PBMs profit from every claim, regardless of true cost savings.
📉 Members and employers unknowingly cover these undisclosed “tolls.”

Bottom line: 🧠
When PBMs control both pricing and payment terms, every network transaction becomes an opportunity—not for savings, but for spread.

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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