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Pharmacy Benefit Manager (PBM)

A company that manages prescription drug benefits for health insurance plans, including negotiating drug prices with manufacturers and pharmacies.

Medicare Part D

The part of Medicare that provides prescription drug coverage.

Manufacturer Rebate

A payment made by a drug manufacturer to a PBM or health plan, often in exchange for favorable placement of the drug on a plan's list of covered medications.

Ingredient Cost

The actual cost of the drug itself, excluding dispensing fees or other charges.

Dispensing Fee

A fee paid to a pharmacy for the professional services involved in filling a prescription, separate from the cost of the drug.

Steering

Practices by a PBM that might direct patients to specific pharmacies or drug options, potentially limiting patient choice or favoring affiliated businesses.

Coinsurance/Copayment

The portion of a medical or prescription drug cost that a patient is responsible for paying after their insurance has paid its share.