What is the reimbursement rate that a pharmacy agrees to accept from a specific PBM?

The term "contract rate" refers specifically to the reimbursement rate that a pharmacy agrees to accept from a particular pharmacy benefit manager (PBM) as part of their contractual agreement. This rate is negotiated between the pharmacy and the PBM and is established to define how much the PBM will pay the pharmacy for the prescription drugs dispensed to beneficiaries covered under the plan.

Understanding the contract rate is crucial as it affects the pharmacy’s revenue and the overall cost to patients. By having a defined contract rate, both the pharmacy and the PBM have clear expectations regarding reimbursement for services and medications provided.

The other terms—effective rate, standard rate, and going rate—do not specifically pertain to the unique agreement between a pharmacy and a PBM. The effective rate might refer to the actual payment received after adjustments like discounts or reimbursements, while the standard rate could imply a typical or average payment benchmark that isn't necessarily tied to a specific contract. The going rate might refer to the rate that is prevailing in the market but does not capture the specific negotiated terms between one pharmacy and one PBM. Thus, "contract rate" is the most fitting term in this context.