Follow the Dollar: How Funds Flow in the Distribution and Reimbursement Channels

The U.S. pharmacy distribution and reimbursement system is highly complex and includes three primary flows among the industry’s participants. This module offers a fundamental grounding in these crucial and often misunderstood interactions:

  • Product movement, which traces bulk distribution from pharmaceutical manufacturers to the drug wholesalers that supply pharmacies. A pharmacy marks the final step in which a prescription is dispensed to a patient.
  • Financial flows, which transfer money from third-party payers to Pharmacy Benefit Managers (PBMs), who in turn reimburse pharmacies. Funds flow to manufacturers via pharmacies, which purchase drugs from wholesalers.
  • Contractual relationships, which govern the relationships between:
    1. payers and PBMs
    2. PBMs and pharmacies
    3. pharmacies and wholesalers
    4. wholesalers and manufacturers
    5. manufacturers and PBMs

After completing this course, learners will be able to identify and describe:

  • The key participants in the U.S. distribution and reimbursement channel
  • The difference between financial flows and product movement
  • The factors influencing a third-party payer’s total prescription cost
  • The financial relationship between:
    • manufacturers and pharmaceutical wholesalers
    • pharmaceutical wholesalers and pharmacies
    • pharmacies and pharmacy benefit managers (PBMs)
    • pharmacy benefit managers (PBMs) and third-party payers
    • pharmacy benefit managers (PBMs) and manufacturers

View a sample of our modules. Or, email Paula Fein (, VP of Business Development, to learn more.