PBM + GLP-1 Leak Map:
27 Questions Vendors Don't Want You Asking
A 1-page checklist that exposes where employer health plans leak money—PBM pricing, rebate games, specialty pharmacy control, and GLP-1 financial architecture.
Section 1 — PBM Pricing & Spread (1–9)
Guarantee basis, MAC lists, spread risk, specialty classification, and reconciliation discipline.
Section 2 — Rebates & "Rebate Games" (10–15)
Pass-through definitions, timing, aggregator fees, and non-rebate manufacturer payments.
Section 3 — Specialty Pharmacy & Channel Control (16–20)
Ownership structures, site-of-care steering, waste policies, and limited networks.
Section 4 — GLP-1 Financial Control (21–27)
Exposure tracking, utilization management, dose escalation, discontinuation signals, and PEPM impact modeling.
Red Flags
- •"We can't provide claim-level detail."
- •"Rebates are proprietary."
- •"Specialty classification changes without notice."
- •"Portfolio-average guarantees only."
- •"No clear evidence trail from invoice → claim lines."
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Used by CFOs and CHROs at mid-market and large employers to pressure-test vendor economics and defend plan strategy with evidence.