After several weeks of exploration and analysis, we have concluded that the new PBM contract design announced by Express Scripts and the National Drug Purchasing Coalition on October 23rd represents a significant evolution of the PBM model that could point to the future of pharmacy benefit management in a world without rebates.

Key Topics:

• Where does the money go?   
  • We quantify the factors that account for the $153bn gap between brand gross and net and segment PBM profit pools 

• Total Performance Management model mechanics 
  • Who is NDPC and what makes the model developed by Express and NDPC different from previous acquisition cost-plus models? 

• Implications of a transparent model 
  • We consider the potential impact on PBMs, Pharma, payors/employers and benefit managers with an eye on the JPM, Amazon, Berkshire partnership