Which factor does NOT influence rebates from pharmaceutical manufacturers to PBMs?

Rebates from pharmaceutical manufacturers to Pharmacy Benefit Managers (PBMs) are influenced by several strategic factors that affect how these agreements and incentives are structured in the context of drug pricing and market dynamics.

The first key factor influencing rebates is achieving specific market shares. Manufacturers often provide rebates to PBMs in order to increase the market share of their products. The goal is to have more patients using their medications over competitors, and PBMs can use rebates as a tool to incentivize the inclusion of those medications in preferred drug lists.

Another important factor is the product's "preferred" status on formulary lists. When a medication is given a preferred status, it means that it is more likely to be covered at a lower cost for patients, enhancing its attractiveness over alternative therapies. Pharmaceutical companies will often provide higher rebates for products that attain this preferred positioning, as it can significantly boost sales volumes.

When considering the availability of a drug in multiple therapeutic categories, this can also play a role in the willingness of manufacturers to provide rebates. A product that can serve various indications may be viewed as more versatile and desirable, leading companies to offer rebates to secure broader market access across different patient populations.

On the other hand, cash disbursement rates are not a factor that directly