Navigating PBM Pitfalls: Protecting Revenue in a Complex Rebate Landscape

In this episode of Pricing & Policy with Model N, Jesse Mendelsohn, senior vice president at Model N, joins host Mike Christel to offer a candid, expert-driven look at the pharmacy benefit manager (PBM) landscape, including the operational complexities confronting biopharma manufacturers and what these companies must understand to protect their revenue and expand patient access. Mendelsohn cuts through the spin to examine where PBM reform efforts are progressing and falling short, how payer vertical integration is compounding financial risk for manufacturers and why the onus increasingly falls on drugmakers themselves to police the data, the contracts and the dollars at stake.

01:32 - PBM scrutiny: Where it’s missing the mark

05:54 - Pharma’s chief PBM concerns 

08:08 - Formulary compliance and transparency

12:00 - Data correlation and rebate accuracy

18:00 - Addressing multipayer-claim complexity

19:03 - Benefit-claim breakdowns: The 340B effect 

20:14 - Why coordination issues persist 

21:16 - Independent PBMs: Is their model game-changing?

26:01 - PBM reform potential and pace

29:09 - Future pressure points for manufacturers