Investor Presentaiton
On average, the estimated profits for national chain and specialty/mail order pharmacies are more than
twice the amount independent pharmacies receive.
In our testing, we estimate independent pharmacies, on average, are reimbursed less than national
chain pharmacies for most of the 13 drugs tested. For example, for each Eliquis prescription dispensed,
independent pharmacies lost on average about $3, whereas national chains made over $5. As we only
tested a small portion of pharmacy claims, we cannot conclude other drugs would show these same
disparities.
Figure 15: Medicaid PBMs consistently reimbursed pharmacies significantly below average acquisition cost
for more than 70,000 albuterol sulfate prescriptions in 2021
PBM 1
$0
($5)
($10)
($15)
($20)
($25)
($30)
-$32
($35)
PBM 2
-$24
PBM 3
PBM 4
PBM 5
PBM 6
-$9
-$13
-$14
-$17
Source: Auditor analysis of OHA and PBM 2021 claims data and Oregon Average Acquisition Cost data
Figure 16: Estimated pharmacy profits for some brand name drugs differ significantly depending on
pharmacy type
$125
■National chain
■Specialty/mail order
Humira
Trulicity
Biktarvy
■Independent
Buprenorphine
Budesonide
$100
$75
$103
$64
mla
$50
$61
$58 $58
$53
$48
$25
$33
$27
$0
-$15
$23
$45 $48
$7
($25)
Source: Auditor analysis of OHA and PBM 2021 claims data and Oregon Average Acquisition Cost data
Oregon Secretary of State Report 2023-25 | August 2023 | page 22
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