Pharmacy Benefit Management: Decoding the Complex World of Pharmacy Benefit Manage Insights and Implications
What is Pharmacy Benefit Management?
A pharmacy benefit manager or PBM oversees the prescription drug benefits offered by many types of health insurance plans. PBMs design prescription drug formularies, negotiate rebates and discounts with drug manufacturers, and work to control costs for payers such as health plans and self-funded employers.
Role of Pharmacy Benefit Managers
Pharmacy Benefit Management play an important role in managing the rising costs of prescription drugs. Here are some of the key responsibilities of a PBM:
Drug Formulary Management
covered drugs under a health plan. Drugs are assigned tiers based on their costs and potential alternatives. Higher tier drugs require larger copays from plan members to encourage use of lower-cost options. PBMs negotiate with drug makers to add lower-cost generics and biosimilars to formularies.
Rebate Negotiations
PBMs leverage their large member base to
What is Pharmacy Benefit Management?
A pharmacy benefit manager or PBM oversees the prescription drug benefits offered by many types of health insurance plans. PBMs design prescription drug formularies, negotiate rebates and discounts with drug manufacturers, and work to control costs for payers such as health plans and self-funded employers.
Role of Pharmacy Benefit Managers
Pharmacy Benefit Management play an important role in managing the rising costs of prescription drugs. Here are some of the key responsibilities of a PBM:
Drug Formulary Management
covered drugs under a health plan. Drugs are assigned tiers based on their costs and potential alternatives. Higher tier drugs require larger copays from plan members to encourage use of lower-cost options. PBMs negotiate with drug makers to add lower-cost generics and biosimilars to formularies.
Rebate Negotiations
PBMs leverage their large member base to
3 months ago
