Did you know… Pharmacy benefit managers (PBMs) do more than reduce the cost of prescription drugs – by $300 billion each year. PBMs also play an important clinical role. PBM clinicians support patients suffering from chronic conditions by helping them stay on the appropriate medications and avoid potentially harmful drug interactions that would make their condition worse. Behind the scenes, they conduct safety checks on prescriptions and provide doctors with resources that help inform their prescribing decisions.

Personalized Support for Patients Who Need It the Most

Medication therapy management programs focus on patients who need the most support, particularly those taking multiple medications. Through one-on-one consultations, PBM pharmacists help patients better understand their treatment, identify potential issues, and make practical recommendations to keep their care on track.

PBMs also provide disease-specific management programs to support patients with challenging conditions. Some examples of these programs include:

• Helping Patients with Asthma Breathe Easier: Using claims data, PBMs monitor whether patients are on the appropriate asthma medications, reach out to patients, and provide educational materials or counseling if needed. Some PBMs track asthma patients’ adherence by sending at-risk patients a device to attach to the top of their inhalers. That device allows usage and dosage information to be sent to their PBM.
• Empowering Patients with Diabetes to Manage Their Health with Confidence: PBMs work with certified diabetes care and education specialists to deliver individualized education and care management to patients. Clinical experts also assist patients with lifestyle changes, including nutrition and exercise.
• Supporting Better Outcomes and Adherence to Glucagon-like Peptides 1 (GLP-1s): Many PBMs offer holistic support programs that combine lifestyle changes and a GLP-1 drug. These programs often consist of a behavior support component where the patient is helped to make permanent changes, including diet and exercise, in tandem with the use of GLP-1s. PBMs work closely with employers, unions, and government programs to incorporate the lifestyle program that best fits the needs of their members.

PBMs are in a unique position to help close the gap between treatment and outcomes by actively supporting patients and clinicians. Disease management programs are just one way that PBMs deliver not just savings, but also services and safety for American families.