Export Pack
Negotiation-ready documentation for PBM conversations
Asepha PSAO Network
DIR Exposure & Negotiation Brief
Generated: 12/12/2025
Prepared by Asepha Inc.
Network Summary
Projected POS Withholds
$18,200,000
Expected Net Loss
$15,500,000
Peer Benchmark
-12%
Member Pharmacies
2,500
Risk Heatmap & Peer Benchmark
Geographic Risk Distribution
Highest exposure concentrated in TX, CA, and GA regions. These states represent 42% of total network pharmacies and 58% of projected DIR exposure. Immediate intervention recommended for high-risk pharmacies in these markets.
Peer Benchmark Analysis
Top Quartile
3.8% DIR
National Median
5.2% DIR
Bottom Quartile
7.1% DIR
Contract Clauses Driving Exposure
Analysis of Express Scripts Performance Network Agreement reveals the following high-impact clauses contributing to network-wide DIR 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
True-up reconciliation occurs quarterly
No mid-contract renegotiation clause
Top 5 At-Risk Pharmacies
1. Riverside Pharmacy
TX
PDC
78.5%
GDR
82.3%
Forecast DIR
6.8%
POS Withholds
$85,000
2. Oakwood Drugs
CA
PDC
81.2%
GDR
85.1%
Forecast DIR
6.2%
POS Withholds
$72,000
3. Maple Street Pharmacy
FL
PDC
83.5%
GDR
87.2%
Forecast DIR
5.8%
POS Withholds
$65,000
4. Central Care Pharmacy
NY
PDC
85.1%
GDR
89.5%
Forecast DIR
5.4%
POS Withholds
$58,000
5. Wellness Pharmacy
PA
PDC
87.8%
GDR
91.3%
Forecast DIR
5.0%
POS Withholds
$52,000
Appendix: Methodology & Data Sources
Forecasting Methodology
DIR exposure forecasts are calculated using a proprietary algorithm that analyzes historical performance metrics (PDC, GDR, Statin-in-Diabetics), contract terms, and claims data. The model applies contract-specific thresholds and DIR schedules to project POS withholds and quarterly true-up adjustments.
Data Sources
- • PBM portal exports (claims, DIR reports, reconciliation statements)
- • Contract PDFs and addenda (parsed via Contract Intelligence Agent)
- • Pharmacy management system (PMS) data feeds
- • CMS Star Ratings and quality measure benchmarks
- • National peer cohort data (anonymized, aggregated)
Disclaimer
This export pack contains mock data for demonstration purposes only. Actual DIR exposure and performance metrics will vary based on real contract terms, claims data, and PBM reconciliation processes.