标题： 一种药品福利管理保险商业模式 显示英文标题

标题： A Pharmacy Benefit Manager Insurance Business Model

摘要： 现在是时候停止尝试使药房福利管理公司（PBM）转售商业模式更加透明了。 一再地，三大PBMs开发出了不透明的替代方案，以规避分项100%全额转嫁的规定。 一再地，PBMs展示了在发现州政府披露法律中的漏洞方面的专业能力。 本文的目的是提供两种透明保险商业模式的定量估计，作为解决PBM代理问题的方案。 所使用的关键参数是三大PBMs自己披露的8%毛利润率。 根据向计划提供的药物趋势数据，我们将$1,200 to $1,500每年每位成员（PMPY）作为这一关键绩效指标（KPI）的范围。 我们建议讨论PBM保险商业模式时从以下数字开始： (1) 固定保费模式，医疗损失比率在92%到85%之间；(2) 按服务收费模式，PMPY为$96 to $180，与合同规定的PMPY药物支出偏差进行风险共担。 显示英文摘要

摘要： It is time to move on from attempts to make the pharmacy benefit manager (PBM) reseller business model more transparent. Time and time again the Big 3 PBMs have developed opaque alternatives to piece-meal 100% pass-through mandates. Time and time again PBMs have demonstrated expertise in finding loopholes in state government disclosure laws. The purpose of this paper is to provide quantitative estimates of two transparent insurance business models as a solution to the PBM agency issue. The key parameter used is an 8% gross profit margin figure disclosed by the Big 3 PBMs themselves. Based on reported drug trend delivered to plans, we use a $1,200 to $1,500 per member per year (PMPY) as the range for this key performance indicator (KPI). We propose that discussions of PBM insurance business models start with the following figures: (1) a fixed premium model with medical loss ratio ranging from 92% to 85%; (2) a fee-for-service model ranging from $96 to $180 PMPY with risk sharing of deviations from a contracted PMPY delivered drug spend.