Which contract type involves the plan sponsor paying a per employee per month fee and the PBM acting almost like the insurer?

The contract type that involves the plan sponsor paying a per employee per month fee, with the pharmacy benefit manager (PBM) acting almost like the insurer, is indeed capitated. This arrangement allows the PBM to receive a fixed amount for each enrolled member, providing a predictable cost structure for the plan sponsor. In a capitated model, the PBM is responsible for managing the pharmacy benefits and assumes financial risk for the costs of covered medications for the enrolled individuals. This incentivizes the PBM to manage the prescriptions effectively to keep costs down while ensuring that beneficiaries receive the medications they need.

In contrast, the other types of contracts have different structures and risk distributions. For instance, a fiduciary contract places the responsibility for managing the plan in the hands of the PBM, but it typically involves a different fee model and does not specifically entail a per member payment structure. Fee-for-service contracts are based on services provided, where the PBM charges for each service rendered rather than a flat fee per member. Shared savings models involve cost-sharing mechanisms where savings are shared between the plan sponsor and the PBM, but again, this doesn't align with the fixed payment structure characteristic of a capitated arrangement.