The Pharmacy Benefit Brief | November 2021

Welcome to the Pharmacy Benefit Brief. This brief is your monthly snapshot of news from America’s prescription drug supply chain including pharmacy benefit managers, independent pharmacies, and drug manufacturers.



There’s a lot of jargon in the prescription drug and pharmacy distribution world, and the meaning sometimes isn’t known to everyone. A good example would be “white bagging.”

White bagging is when a specialty pharmacy safely and efficiently sends a prescription drug that requires health care provider administration directly to the health care provider (ex: physician, hospital). The health plan sponsor reimburses the specialty pharmacy for the medication and reimburses the provider for the drug’s administration.

Here’s why white bagging is worth knowing about: it can make treatment less expensive for patients and those providing their health insurance. The drugs can cost less when they are distributed through a specialty pharmacy and billed through the prescription drug benefit than through the provider “buy and bill” method through the medical benefit. White bagging also provides a service for physicians who don’t want to buy and store these specialty medications at their practices. As a reminder, specialty medications generally require special storage and handling; are very expensive; have short shelf-lives; and are for patients with rare or complex medical or disease conditions.

In addition, health care providers – physicians and hospitals – may bill significantly higher for prescription drugs, which means patients will have higher cost sharing. But through white bagging, patients can receive physician-administered prescription drugs through a specialty pharmacy at a lower overall cost. Also, prescription drug claims, or payments, are processed in real time, which supports patient awareness of their cost sharing in advance of the drug being administered.



Results are in for the annual comprehensive pharmacy benefit manager, PBM, customer satisfaction research released by Pharmaceutical Strategies Group (PSG). This year’s report shows the overall satisfaction score for PBM customer satisfaction is up from 8.0 to 8.2 on a 10-point scale.

See the full PSG report here: The most comprehensive research on PBM customer satisfaction

The PSG PBM satisfaction report also covers Utilization Management, or as it’s often referred to, UM. UM can be a hot topic in state prescription drug pricing regulation and legislation – it is one way PBMs ensure that patients get the most clinically efficacious and cost-effective drugs available for their disease condition.

Senior Vice President and Practice Leader of Employer Groups, Labor, and Health Systems at PSG Tracy Spencer commented in a PSG press release on the importance of Utilization Management programs.

“UM programs are a vital tool in the clinical and cost management of drug. More than two-thirds of respondents reported they currently use prior authorization (88%), formulary exclusions (87%), step therapy (85%), and opioid management programs (69%).”



JC Scott, President, PCMA spoke with Tim Dube from PCMA and Julie Goon at Anthem, Inc. about PBM transparency. Their podcast explains good versus bad transparency, and the impact it can have on patients.

Listen to the latest edition of The Pharmacy Benefit: PBM Transparency


Also, check out Politico’s “5 Ways Pharmacy Benefit Managers Improve Patient Outcomes.” to learn how PBMs help improve clinical outcomes for patients.

What is a PBM? Watch the short video here.

America’s pharmacy benefit managers (PBMs). PBMs are advocates for consumers and health plans in the fight to keep prescription drugs accessible and affordable. PBMs administer prescription drug plans for 266 million Americans and have been able to achieve an overall stable cost trend for prescription drugs by innovating consumer-friendly, market-based tools that encourage competition among drug manufacturers and drugstores and incentivize consumers to take the most cost-effective, clinically appropriate medication.