Network DIR / True-Up Forecast
Real-time exposure visibility across your PSAO network
Instant visibility: See exposure without waiting for PBM reconciliation
Peer benchmark: Know where you stand against national cohorts today
Projected POS Withholds
$18,200,000
Expected Net Loss After True-Up
$15,500,000
Peer Benchmark Position
-12%
below national avg
Member Pharmacies
2,500
PBM Comparison (DIR % vs Exposure)
PBM Summary
| PBM | Stores | PDC | GDR | SUPD | Health | Action | ||
|---|---|---|---|---|---|---|---|---|
| CVS Caremark | 840 | 5.8% | $9.2M | 78.5% | 82.3% | 71.2% | 62 | View Details |
| OptumRx | 560 | 5.1% | $5.7M | 85.1% | 89.5% | 81.2% | 78 | View Details |
| Humana | 440 | 6.3% | $4.8M | 76.2% | 80.1% | 68.5% | 55 | View Details |
| Express Scripts | 390 | 5.5% | $4.1M | 83.5% | 87.2% | 78.3% | 70 | View Details |
| Prime | 270 | 5.0% | $2.3M | 87.8% | 91.3% | 84.5% | 80 | View Details |
| Aetna | 190 | 5.4% | $1.6M | 81.2% | 85.1% | 74.8% | 73 | View Details |
Forecast Over Time
Monthly DIR percentage and withhold projections
Risk by State/Region
Geographic distribution of DIR exposure
TX
450 pharmacies
Avg DIR: 6.8%
CA
380 pharmacies
Avg DIR: 6.5%
FL
320 pharmacies
Avg DIR: 5.9%
NY
290 pharmacies
Avg DIR: 5.7%
PA
260 pharmacies
Avg DIR: 5.2%
OH
240 pharmacies
Avg DIR: 5.0%
IL
220 pharmacies
Avg DIR: 5.8%
GA
200 pharmacies
Avg DIR: 6.3%
Pharmacy Risk Summary
Click any row to view detailed snapshot
| Pharmacy | POS Withholds | Expected True-Up | Risk | ||||
|---|---|---|---|---|---|---|---|
| Riverside Pharmacy | 78.5% | 82.3% | 71.2% | 6.8% | $85,000 | $18,200 | High |
| Oakwood Drugs | 81.2% | 85.1% | 74.8% | 6.2% | $72,000 | $14,500 | High |
| Maple Street Pharmacy | 83.5% | 87.2% | 78.3% | 5.8% | $65,000 | $11,200 | Medium |
| Central Care Pharmacy | 85.1% | 89.5% | 81.2% | 5.4% | $58,000 | $9,800 | Medium |
| Wellness Pharmacy | 87.8% | 91.3% | 84.5% | 5.0% | $52,000 | $7,500 | Low |
Negotiation Readiness
Top clauses driving exposure
- •Adherence <85% triggers 7% DIR withhold
- •GDR <90% adds 2% additional withhold
- •Statin-in-Diabetics <80% adds 3% withhold
- •Quality bonus only applies at 4.5+ stars
Peer Benchmark
National cohort comparison
Top Quartile3.8% DIR
Median5.2% DIR
Bottom Quartile7.1% DIR
Exec Notes
Private notes and observations