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November 21, 2023

Q1:

AstraZeneca gives a 3% rebate to a PBM for placing Farxiga on Tier 2 (preferred branded)

Farxiga WAC price = $418.00; 30-day supply (1 unit)

XYZ Health Plan has $30.00 patient copay for 30-day supply for Tier 2 drugs

PBM charges AstraZeneca admin fees of 0.8% based on products total dollars sold.

PBM charges AstraZeneca 1.2% for data fees based on products total dollars sold.

PBM gives 95% of rebates collected to XYZ health plan.

PBM charges XYZ health plan $0.50 per prescription processed

PBM processed 105,000 units of Faxiga in the year for XYZ health plan

Based on the data provided above, answer the following three questions (Show your calculations)

1. How much revenue did PBM earn in this scenario in the year?

2. How much does a patient pay for Farixiga in the year?

3. How much did XYZ Health Plan pay for Farxiga in the year?

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