Manufacturer

s
ct
tra
Rebate payment

on
es C

of to
ic e

Reb
s) rn t
pr rvic

ie tu en
or re m
st e

ate
Li & S

nt (& ip
ve s sh
Policy / formulary

Agr
Manufacturer

in ter ct
tio

ss en du
bu
pays % fee to reimbursement optimization

ce c ro

eem
tri
Payment instructions

ex ion p
wholesaler for is

ut ME
D

ent
distribution

rib D
st /
service. Based

di ulin
on wholesale
s
price. In

Wholesaler PBM IBM

Reimbursement of
monthly balance

Gag rice lis ent

In (Reconciliation)

Customer plan selection

IT su

m
t
se lin

MAC k Agree
Su sh

se

ct
rv p

Service Contract
ic pl ip

Service Fees
a
clau
es y m

ntr
co / Pr en

Co
tt

or
nt im o
ra e Ph

ice
Netw
ct ve ar Payments

rv
(in nd m instructions
ac

Se
ve or
nt C y via IT network at
or on
y t POS
m rac
an t
ag & Reimbursement
DME em
en & Service Fees
Not represented on t)
this graph Pharmacy payment for product Pharmacy Insurer / Payer ACA plan
Actual Acquisition Cost (AAC) = list price subsidies
List price, Plan
Dispense
pays receipt
prescription ACA subsidized
plan participation
m ent and cost data
Reimbursement instructions
Copay or Customer / Insured m pay
miu
Cash flow Coinsurance Pre
payment US GOV
Contractual relationship
Plan summary, EOB
Transfer of drug/DME

Custody of drug/DME but no transfer of ownership

Tax deduction (HSA), ACA tax exemption
©Type 1 Diabetes Defense Foundation