Every year, like clockwork, drug prices go up. For many patients, those increases aren’t just numbers on a chart; they’re real barriers to getting the care they need. That’s where pharmacy benefit managers (PBMs) come in, helping to mitigate the financial pressures and barriers to access that come with high drug prices.
PBMs’ core mission is simple: Help health plan sponsors manage and reduce drug costs for patients. We know the impact that high prices have on patients. That’s why we’re not waiting for mandates or legislation—PBMs are taking action. Across the industry, PBMs are rolling out innovative programs to employers and health plan sponsors that are designed to directly help patients and make drugs more affordable and accessible. These aren’t just ideas—they’re real solutions that are already helping patients.
Lowering drug costs and increasing affordable access requires constant innovation and adaptation to changing market conditions. The PBM Innovation Report and the interactive website detail the programs that PBMs are offering. Our report focuses on six key areas where PBMs are making a difference:
Patient Out-of-Pocket Cost-Sharing Programs
PBMs offer health plan sponsors programs and ideas to help patients afford and access their prescriptions through initiatives like $0 cost sharing, discount cards, and coupons.
Patient Transparency Tools
PBMs offer tools that provide transparency, facilitating convenient access to information that empowers patients.
Pharmacy Innovation Programs
PBMs across the industry are partnering with independent pharmacies to best serve their patient populations and provide patients with a higher-quality, lower-cost pharmacy experience.
Biosimilar Access
PBMs work with health plan sponsors to break down the barriers to biosimilars, making them more accessible and affordable.
Access to GLP-1s for Weight Loss
PBMs are pioneering wholistic support programs that combine lifestyle changes and weight loss medications.
Medication Adherence
PBMs are working to support patients by pairing technology with their expertise to provide medication adherence programs that help patients take their drugs safely and appropriately.
PBMs are innovating in all areas across the prescription drug space, not just the six highlighted areas. Innovation doesn’t stop here. As patient and plan sponsor needs evolve, so will PBM efforts. This project will grow as we continue showcasing the other areas where PBMs address patient needs.
