CompletedVideo · 18 min
Spread Pricing and Formularies
The difference between what the plan is billed and what the pharmacy is paid — and how preferred placement is purchased.
Spread pricing is the oldest PBM margin. It is also the one plan sponsors have spent a decade trying to legislate away. What replaced it is a thicker stack of fees that do not appear as spread and do not appear as a rebate either.
Formulary placement is the lever. Preferred, excluded, or prior-authorized is a commercial outcome. This lesson walks the same examples the Outlook briefing uses with manufacturer brand teams.
Key takeaways
- Spread is one ledger, not the only one
- Exclusion is a price
- Fees migrated off the claim