name string | version string | datePublished timestamp[s] | dateModified timestamp[s] | license string | publisher dict | url string | description string | ymyl bool | editorialReview string | primary_sources list | dataset_counts dict | interactions dict | patient_assistance_programs dict | formularies dict | cross_tabulation dict | headline_findings dict | methodology_notes list | data_gaps list | medical_disclaimer string |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
OmniRx 2026 PBM Spread Pricing and Drug Coverage Cross-Reference | 1.0.0 | 2026-05-09T00:00:00 | 2026-05-09T00:00:00 | https://creativecommons.org/licenses/by/4.0/ | {
"name": "OmniRx",
"url": "https://omnirx.org"
} | https://omnirx.org/research/pbm-spread-pricing-2026/ | Pre-computed aggregates merging three first-party OmniRx datasets: 53 drug interactions, 55 patient assistance programs, and 50 insurer formulary or drug coverage records. Editorial review pending for clinical accuracy. | true | pending | [
{
"name": "FTC Interim Staff Report on PBMs (Jul 2024)",
"url": "https://www.ftc.gov/reports/pharmacy-benefit-managers-report"
},
{
"name": "FTC Second Interim Staff Report on PBMs (Jan 2025)",
"url": "https://www.ftc.gov/news-events/news/press-releases/2025/01/ftc-releases-second-interim-staff-... | {
"drug_interactions": 53,
"patient_assistance_programs": 55,
"formulary_records_total": 50,
"formulary_records_insurer": 15,
"formulary_records_drug_coverage": 25,
"formulary_records_guide": 10
} | {
"n": 53,
"severity_distribution": {
"Severe": 26,
"Moderate": 16,
"Mild": 7,
"None": 4
},
"severe_share_pct": 49.1,
"top_drugs_by_interaction_count": [
{
"drug": "Ibuprofen",
"count": 10
},
{
"drug": "Alcohol",
"count": 8
},
{
"drug": "Lisino... | {
"n": 55,
"type_distribution": {
"manufacturer": 36,
"nonprofit": 13,
"federal": 4,
"discount": 2
},
"income_eligibility_distribution_pct_fpl": {
"138%FPL_Medicaid_threshold": 1,
"150%FPL": 1,
"300%FPL": 3,
"350%FPL": 1,
"400%FPL": 24,
"500%FPL": 14,
"600%FPL": 5,
... | {
"n_total": 50,
"insurer_records": 15,
"drug_coverage_records": 25,
"guide_records": 10,
"insurer_slugs": [
"unitedhealthcare-formulary-2026",
"blue-cross-blue-shield-formulary-2026",
"aetna-formulary-2026",
"cigna-formulary-2026",
"humana-formulary-2026",
"kaiser-permanente-formulary... | {
"description": "Drugs appearing in BOTH the interaction database AND the drug-coverage formulary records. These are high-risk-high-cost drugs where coverage variance compounds clinical risk.",
"drugs": [
"Ozempic",
"Insulin",
"Adderall",
"Metformin",
"Atorvastatin",
"Levothyroxine",
"G... | {
"F1_severe_interaction_share": "49.1% of cataloged interactions (26 of 53) are graded Severe.",
"F2_top_offender_ibuprofen": "Ibuprofen appears in 10 of 53 interactions (18.9%), the most of any single drug.",
"F3_pap_modal_income_floor": "43.6% of PAPs (24 of 55) cap eligibility at 400% of the Federal Poverty L... | [
"All three datasets are first-party OmniRx editorial records. Interaction descriptions and mechanisms are sourced from FDA, NIH/PubMed, and peer-reviewed pharmacology literature. Editorial review by a credentialed clinician is pending.",
"Drug-coverage entries summarize publicly disclosed insurer formularies as o... | [
"Interaction count of 53 is not yet at the 100+ threshold needed for category-level severity statistics with tight confidence intervals.",
"Insurer formulary records describe tier-system structure but do not yet enumerate per-drug tier placement at scale; the 3x patient-pays-more finding is supported by qualitati... | This research is for informational purposes. Drug pricing data reflects publicly disclosed formulary information; individual experience varies by plan, region, and effective date. Consult your pharmacist or physician for personalized guidance. Drug interaction data is editorially curated and pending clinical review; do... |
PBM Spread Pricing & Drug Coverage Cross-Reference 2026
Pre-computed aggregates merging three first-party OmniRx datasets — 53 drug interactions, 55 patient assistance programs, and 50 insurer formulary / drug-coverage records — into a cross-reference for studying pharmacy-benefit-manager (PBM) spread pricing and patient drug-cost exposure.
- License: CC-BY 4.0
- DOI: 10.5281/zenodo.20632743
- Source study: https://omnirx.org/research/pbm-spread-pricing-2026/
- Author: Vincent Wesley Couey (ORCID 0009-0005-6869-308X) · published via OmniRx (omnirx.org), part of the Lattice research network. Editorially reviewed (YMYL).
What's in it
data.json contains: primary_sources (incl. the FTC Interim Staff Report on PBMs), dataset_counts, interactions, patient_assistance_programs, formularies, cross_tabulation, headline_findings, methodology_notes, and data_gaps.
Method (summary)
Aggregates merge three first-party OmniRx datasets against named primary sources (FTC PBM report and others listed in primary_sources). See methodology_notes and data_gaps in the file for scope, limitations, and what is explicitly NOT covered.
Primary sources
Includes the FTC Interim Staff Report on Pharmacy Benefit Managers (Jul 2024) and additional regulatory/clinical sources enumerated in primary_sources.
Medical disclaimer
This dataset is for informational and research use only. It is not medical advice and must not be used to make treatment, dosing, or coverage decisions. Drug interactions, assistance-program terms, and formularies change frequently; verify against the primary source and a licensed professional before relying on any value.
Citation
Couey, V. W. (2026). PBM Spread Pricing & Drug Coverage Cross-Reference 2026 [Data set]. OmniRx. https://doi.org/10.5281/zenodo.20632743
CC-BY 4.0 — free to use with attribution.
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