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Direct and Indirect Remuneration (DIR)

November 26, 2019
America’s pharmacy benefit managers (PBMs) are dedicated to controlling drug costs by encouraging competition among drug manufacturers and pharmacies and incentivizing consumers to take the most costeffective, clinically appropriate medications. PBMs facilitate patient pharmacy care management and provide real-time information
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Specialty Pharmacies

July 19, 2016
Specialty pharmacies were established in direct response to the industry’s need to better procure, store, and dispense specialty drugs, as well as better manage therapy for patients on specialty drugs. Among other things, these pharmacies specialize in the unique storage
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Key 1

January 9, 2023

Unlocking an Affordable Future: Key #1 Ensure System Sustainability ENSURE SYSTEM SUSTAINABILITY BY PROMOTING COMPETITION A competitive private market is the best way to manage drug costs. Interventions should be focused on fixing specific market failures or gaps rather than

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Pharmacy Contracting & Reimbursement

July 19, 2016
PBMs contract with pharmacies on behalf of health plans and employers to serve patients by building networks of preferred pharmacies. As part of the negotiations to become a preferred network provider, pharmacies and PBMs negotiate contract types, payment rates for
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Final design

October 5, 2021

PBMs: Committed to Helping Patients The Critical Path Forward: Rx Policies to Reduce Patient Costs, Improve Access For America’s pharmacy benefit managers, PBMs, our core mission is to increase access to affordable prescription drugs for all Americans. But more can

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Employers, Unions, & Insurers

July 19, 2016
PBMs administer prescription drug plans for more than 266 million Americans with health coverage provided through Fortune 500 employers, health insurers, and labor unions, as well as through public programs such as Medicare and Medicaid. A common thread connecting all programs
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