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 transparency12:00 - Data correlation and rebate accuracy18:00 - Addressing multipayer-claim complexity19:03 - 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 pace29:09 - Future pressure points for manufacturers