"Since 2011, the difference between pre-rebate costs (known as gross costs) and post-rebate costs (known as net costs) has grown so that the 'gross-to-net bubble' is worth approximately 10% of all Pharmacy spend -- or about $37 billion.... PBM financial improvements are overwhelmingly -- usually 70% or more -- due to higher rebates instead of better discounts or lower fees.... [S]ince rebates are paid to the plan sponsor, members on High Deductible plans still see higher costs ... [S]ome PBMs are offering 'Point of Sale' rebates, where the member on a High Deductible plan sees their cost immediately reduced by the rebate. This approach benefits the member, yet the plan sponsor needs to approve this approach as it affects net plan costs."  MORE >>