The report must give claim level detail on every drug and every class
What the document says“a list of drugs for which a claim was filed and, with respect to each such drug on such list--”
For a plan offered by a specified large employer or that is a specified large plan and is not insured, or where the opt-in is made, the report must list each drug claimed with what the plan paid the manager, what the pharmacy was paid, the difference between the two, the drug's names and code, the dispensing channel, whether it is brand or generic with its cost, claim and unit counts, net price after rebates, out-of-pocket spending, total net spending, rebates and other remuneration received by the plan and by the manager, and manufacturer copay assistance. It must also give the same picture by therapeutic class, formulary placement rationales for drugs over $10,000 in gross spending, and detail on affiliated pharmacies including prices there against other network pharmacies.
What the document actually says“a list of drugs for which a claim was filed and, with respect to each such drug on such list--”
The report must list each drug that was claimed. For each one it must give the facts set out next.
The heart of it is one line: what the plan paid, what the pharmacy got, and the gap. That gap is what the middleman kept.
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