What commercial plans pay your pharmacy — and what they pay the chain down the street.

Every plan we looked at pays brand-name drugs at almost exactly NADAC — a median of 1.00× in the OptumRx plan — and roughly half of brand prices sit below it. For an independent, that is before a dispensing fee that commercial plans set at well under a dollar: 49% of the OptumRx plan's brand prices to unaffiliated independents are under NADAC, and 69% of BCBS Texas's.

Generics are different: a median of 1.59× NADAC, with one price in ten above 3.55×. That spread is the margin pool — and it isn't shared evenly.

In a large national employer plan administered by OptumRx, Walmart's median generic rate is 2.37× NADAC and Walgreens' is 2.05×. Unaffiliated independents get 1.50×; Health Mart Atlas members 1.61×. On a 30-count generic claim, that is $9.44 over acquisition cost at Walmart versus $3.59 at an independent. Pharmacies owned by OptumRx's parent sit near the top of the list at 2.31×. Nearly all of them are Genoa Healthcare, a behavioral-health chain that operates inside community mental health centers; its patients, drug mix, and adherence services differ from a retail pharmacy's, so part of that premium may reflect the care model rather than ownership.

BCBS Texas works the other way. Independents, PSAOs, LTC, and specialty pharmacies are all paid from one shared generic schedule — the same 1.46× NADAC median whichever kind of pharmacy it is — while chains are priced separately and far more unevenly: the middle half of national-chain generic prices runs from 0.55× to 4.13×, and 41% of Walgreens' generic prices are below NADAC (independents: 18%). Which generics land on which side of that range is the story in section 04.

The files expose the contract model itself. Baylor Scott & White Health Plan, administered by Capital Rx, is pass-through: the median brand and generic ingredient price is NADAC at every pharmacy organization, and the pharmacy's margin is a per-claim fee. An independent gets a $10.52 dispensing and $0.99 transaction fee, $11.67 over acquisition cost on every generic claim — about three times the OptumRx plan's median and five times BCBS Texas's.

The fee is where the plan differentiates, and it runs the opposite way to the OptumRx network: the two largest chains get the lowest fees, Walgreens $7.30 and Walmart $8.00, so an independent out-earns both ($8.29 and $8.99 per claim). Kroger's and Albertsons' banners get $11.25 and Costco $12.75. One schedule breaks the pattern: at Albertsons-owned banners (Safeway, Vons, Jewel-Osco, Acme), 43% of generic prices are below NADAC, typically at less than half of it, on drugs the same plan pays every other pharmacy at NADAC.

The trade-off is the tail: under a markup schedule, some generics pay a pharmacy far more than a flat fee would. Pass-through is predictable; the other two are a portfolio. Knowing which you are in, per plan, is the point.

Every price is tied to RxNorm and its primary WHO ATC class, so the chain-versus-independent gap can be read class by class. In the OptumRx plan the chain premium is broad: chains have the higher median generic rate in 58 of 62 therapeutic classes — statins, for example, at 4.45× NADAC versus 2.54× for independents.

BCBS Texas is where the averages hide the most. Its chain schedule is paid far above independents on the maintenance generics patients refill every month — statins at 11.31× NADAC versus 1.33× — and below acquisition cost on short courses: oral steroids at 0.31× and amoxicillin-class penicillins at 0.44×, where independents get 1.09× and 1.40×. Chains come out ahead in 21 of 48 classes. The overall chain median looks unremarkable; the mix is anything but — and the maintenance book is the one that builds a pharmacy's patient relationships.

The prescription drug files publish a negotiated rate for each NDC, but they don't say what it is a rate for. Every comparison on this page assumes it is per NADAC billing unit — one tablet, one milliliter, one gram. If a plan priced the package instead, a 30-count bottle paid at cost would look like 30× NADAC and drag every average above upward. So we tested it, two ways.

The second check is only possible because TwinFyRx normalizes NDC packaging: each package NDC's FDA description is parsed into a total quantity in its billing unit, so “1 bottle in 1 carton / 5 mL in 1 bottle” becomes 5 mL and a carton of four pouched patches becomes 4 each. With that, every high rate can be checked against the packages the product actually ships in.

What we found. No systematic package pricing: products above 3× NADAC line up with one of their own package sizes no more often than they line up with a random product's (64 vs 61 of 4,838). A handful of package-type products do look priced per package — a topical anesthetic cream at about 30× NADAC per gram, the price of a 30 g tube; transdermal patches near the size of a 4-patch carton; an oral chemotherapy sold in 5-capsule bottles. They are at most 1.1% of the prices in any one plan, so the figures above stand. Most other high ratios are real pricing: newer generics whose plan rate hasn't followed NADAC down, and generics a plan pays as brand.