Pharmacy Benefit Managers (PBMs): Generating Savings for Plan Sponsors and Consumers

Pharmacy Benefit Managers (PBMs) now implement prescription drug benefits for some 266 million Americans who have health insurance from a variety of sponsors: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program, state government employee plans, managed Medicaid plans, and others. Working under contract to these plan sponsors, PBMs use advanced tools to manage drug benefit programs that give consumers more efficient and affordable access to medications. Visante was commissioned by the Pharmaceutical Care Management Association (PCMA) to estimate the savings that these PBM tools generate for plan sponsors and consumers.

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PBM Savings: From 2023 to 2032, the current use of PBM tools in the marketplace will save plan sponsors and consumers more than $1 trillion.

  • Commercial plan sponsors and their members will save more than $469 billion.
  • Medicare Part D and its beneficiaries, more than $437 billion.
  • Managed Medicaid plans, more than $100 billion.

PBM tools focus on six primary areas to produce savings:

  • Negotiating rebates from drug manufacturers
  • Negotiating discounts from drugstores
  • Offering more affordable pharmacy channels
  • Encouraging use of generics and affordable brands
  • Reducing waste and improving adherence
  • Managing high-cost specialty medications