Can a PBM legally have different price lists for the clients it bills and the pharmacies it reimburses?

The legality of a Pharmacy Benefit Manager (PBM) having different price lists for clients and pharmacies hinges on regulations that govern transparency and fairness in pharmacy benefit management. The statement that a PBM cannot legally have different price lists aligns with the principle of equitable reimbursement practices, aiming to eliminate disparities that could lead to conflicts of interest or unethical practices.

When a PBM maintains a consistent pricing structure, it fosters trust among pharmacies, clients, and stakeholders. It ensures that pharmacies are reimbursed fairly for the medications they provide, while clients are billed transparently without hidden costs or arbitrary pricing adjustments. Many states and federal laws emphasize the importance of maintaining consistent and fair pricing practices to protect both consumers and pharmacies.

With that said, the nuances of specific situations or contractual agreements might influence how PBMs operate, but the general principle is that different price lists for different parties without clear justification could be viewed as misleading or exploitative, thus reinforcing the understanding that such practices are generally not permitted.