Pharmacy Benefit Managers (PBMs) reduce prescription drug costs and improve convenience and safety for consumers, employers, unions, and government programs. PCMA’s mission is to lead the effort in promoting PBMs and the proven tools they utilize, which are recognized by consumers, employers, policymakers, and others as key drivers in lowering prescription drug costs and increasing access. PCMA monitors and advocates on a range of important health care issues that allow PBMs to continue:
- Lowering pharmacy costs for America’s employers and consumers.
- Protecting affordability and choice in Medicare Part D.
- Lowering pharmacy costs for Medicare beneficiaries.
- Improving safety with specialty pharmacies.
What is a PBM?
Pharmacy Benefit Managers (PBMs) administer prescription drug plans for more than 270 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, managed Medicaid plans, and others.
PBMs are projected to save employers, unions, government programs, and consumers $654 billion – up to 30 percent – on drug benefit costs over the next decade.
PBMs reduce drug costs by:
- Offering Amazon-style home delivery of medications and creating select networks of more affordable pharmacies;
- Encouraging the use of generics and more affordable brand medications;
- Negotiating rebates from drug manufacturers and discounts from drugstores;
- Managing high-cost specialty medications; and
- Reducing waste and improving adherence.