# Spread Pricing **Spread pricing** is the [[Pharmacy Benefit Managers]] (PBM) practice of charging a health plan (often a [[Medicaid]] managed-care plan) more for a drug than the PBM reimburses the dispensing pharmacy, and keeping the difference — the "spread." Unlike a disclosed fee, the spread is margin hidden inside the transaction. ## Why It Matters Spread pricing is one of the clearest examples of how [[Pharmacy Benefit Managers]] extract value without adding it, and state Medicaid audits have repeatedly found large undisclosed spreads. Along with [[Drug Rebate]] opacity, it was a primary target of the **February 2026 PBM reform law** (delinking PBM compensation from drug prices, banning spread pricing in some programs). It belongs to the broader [[Drug Pricing]] story of value captured in the gaps between list, net, and reimbursed prices. See [[Drug Pricing]].