Independent Pharmacy Prescription Margin Calculator

Your costs

Copay card fee (%)

Card fee per Rx ($)

PBM claim fee (%)

Fees and short-pays withheld from PBM payments.

Reject and rework rate (%)

Share of fills that are rejected, reversed or returned to stock.

Minutes per rework

Staff time to redo and re-fit.

Delivery and compliance cost per Rx ($)

Average cost of delivery, counseling and compliance packaging.

Pharmacist and tech blended wage ($/hour)

Payroll taxes and extras (%)

Employer taxes, workers' comp, paid breaks.

Fixed costs ($/month)

Rent, utilities, base staffing, pharmacy software, insurance, licenses. Not owner pay.

Target margin per Rx (%)

After drug cost, rework, fees and staff time.

Your prescription types

One row per kind of fill, such as a generic on a commercial plan or a specialty drug. Enter the drug acquisition cost you pay, not the amount billed. Use 0 for PBM pays on a cash fill. Leave a row empty to skip it.

Prescription type	Copay $	PBM pays $	Drug cost $	Supplies $	DIR / fees $	Staff min	Rx/mo
Rx 1 name	Rx 1 patient copay ($)	Rx 1 PBM payment ($)	Rx 1 drug acquisition cost ($)	Rx 1 vial, label and supplies cost ($)	Rx 1 DIR and post-sale fees ($)	Rx 1 pharmacy staff minutes	Rx 1 prescriptions per month
Rx 2 name	Rx 2 patient copay ($)	Rx 2 PBM payment ($)	Rx 2 drug acquisition cost ($)	Rx 2 vial, label and supplies cost ($)	Rx 2 DIR and post-sale fees ($)	Rx 2 pharmacy staff minutes	Rx 2 prescriptions per month
Rx 3 name	Rx 3 patient copay ($)	Rx 3 PBM payment ($)	Rx 3 drug acquisition cost ($)	Rx 3 vial, label and supplies cost ($)	Rx 3 DIR and post-sale fees ($)	Rx 3 pharmacy staff minutes	Rx 3 prescriptions per month
Rx 4 name	Rx 4 patient copay ($)	Rx 4 PBM payment ($)	Rx 4 drug acquisition cost ($)	Rx 4 vial, label and supplies cost ($)	Rx 4 DIR and post-sale fees ($)	Rx 4 pharmacy staff minutes	Rx 4 prescriptions per month
Rx 5 name	Rx 5 patient copay ($)	Rx 5 PBM payment ($)	Rx 5 drug acquisition cost ($)	Rx 5 vial, label and supplies cost ($)	Rx 5 DIR and post-sale fees ($)	Rx 5 pharmacy staff minutes	Rx 5 prescriptions per month

Result

Questions people ask

What is a good margin on a prescription?

Per fill it is thin and it varies enormously by type. A generic on a good commercial plan can earn several dollars after drug cost, supplies, fees and staff time, while a brand or specialty drug on the same plan often passes almost all of its money straight through to the wholesaler and nets a dollar or two. A generic from a low-reimbursement PBM can lose money on every fill. This tool subtracts drug acquisition cost, vials and supplies, PBM claim fees, DIR and post-sale fees, a rework allowance, copay card fees, delivery and the staff's time, then shows what each kind of fill really earns.

How do PBM reimbursements and DIR fees change the math?

A PBM pays a contracted amount per claim and the patient pays a copay on top. Fees charged after the sale, often called DIR fees, can claw back part of it weeks later. Enter the copay, what the PBM pays, and your DIR and post-sale fees per fill as separate numbers. The card fee applies only to the copay and the claim fee only to the PBM payment, and the tool gives you the copay that would reach your target margin if the PBM payment is fixed.

What does a rejected claim cost?

A rejected or reversed claim costs the vial and supplies again plus staff time to call, resubmit or restock. Multiply by how often it happens. Even a four percent rework rate quietly takes cents from every fill, and the scenario table shows what three more points would cost across a month.

How many prescriptions a month do I need to cover fixed costs?

Divide monthly fixed costs (rent, utilities, base staffing, pharmacy software, insurance, licenses) by the average contribution per fill at your current mix of generics, brands, cash and specialty fills. The result is only as good as that mix, so rerun it if a PBM changes its rates or you add a specialty line.

Not decided

What your market will pay, which PBM networks to join, your contracted rates and DIR terms, wholesaler and buying-group terms, 340B and compliance questions, controlled-substance handling, the pharmacist-in-charge's compensation, and how to treat any of this for tax or accounting. Take costs from wholesaler invoices, take payments and fees from your remittance advices, and talk to your accountant about the books. No patient names or prescription data belong in this page and it never asks for them.