PBM Savings and Patient Impact in California
Pharmacy benefit experts secure lower prescription drug costs and enable better health outcomes for patients.
PBMs will save Californians
$108.35B
across all California insurance markets over ten years (2023–2032).
PBMs will save Californians
$11.8B
over a 10-year period (2023–2032) in California Medicaid.
PBMs cover
35,490,000
Californians.
Nationally PBMs save payers and patients an average of
$1,040
per person per year.
The use of PBM tools will save payers and patients nationally more than
$1 trillion
from 2023–2032.
CLINICAL CARE:
Pharmacy benefit companies use clinical data to support decision-making and help patients stay on course with their prescription therapy through evidence-based medication adherence and health coaching programs.
Nationally, PBMs improve drug therapy and patient adherence in diabetes patients, helping to reduce complications annually of:
- 500,000 emergency department visits
- 330,000 strokes
- 60,000 incidents of end stage kidney disease
- 440,000 heart attacks
- 150,000 amputations
ADHERENCE PROGRAMS:
PBMs monitor and engage with patients to help them stay on their drug course.
- Diabetes: PBMs monitor and measure a patient’s glucose levels through “smart glucometers” and conduct outreach if patients need medication support.
- Asthma: PBMs track asthma patients’ adherence by sending at-risk patients a device to attach to the top of their inhalers, which monitors usage and dosage.
PATIENT SUPPORT PROGRAMS:
PBMs offer affordable access to drugs and engage directly with patients on care.
- PBMs include chronic condition medications on lists of drugs for preventative treatment for which patients pay either no cost sharing or bypass their deductible and pay only their cost sharing.
- PBMs certified care and education specialists deliver individualized education and case management to patients.
Proposed Legislative Impact Facts for California
Ten-Year Cost of Proposals Impacting PBM Tools by State, 2023-2032
Proposals that restrict the use of PBM tools limit options that plan sponsors can use to manage their drug benefit costs. Below demonstrates how projected drug expenditures could increase over the next 10 years as a result.
Beneficiaries in Fully Insured Plan
11,000,887
Cost of Disclosure Mandate
$7,870
Cost of Fiduciary Mandate
$10,133
Cost of Prohibition on PA & ST
$10,255
Cost of Any Willing Specialty Pharmacy
$4,839
Click here to view the full study.
Have questions pertaining to California legislation? Contact PCMA staff member, Bill Head, bhead@pcmanet.org
Pharmacy Access in California
Nationwide, the independent pharmacy marketplace is stable.
In California, between 2014 and 2024, the number of independent pharmacies grew from 2,093 to 2,167, a 4% increase.
39.5% of pharmacies in California are independent pharmacies.
Independent pharmacies say they’re getting squeezed out of business, but according to NCPDP data and the National Community Pharmacists Association (NCPA), the number of independent pharmacies has generally been stable.
The NCPA found that in the last year, the number of independent pharmacies “was essentially flat,” demonstrating a stable marketplace.
Adam Fein’s Drug Channels also found that the independent pharmacies’ financials have also been steady. From 2016 to 2020, the average per prescription gross profit margin for independent pharmacies ranged from 20.8% to 21.1%, showing little fluctuation.
Retail Pharmacies in California
2,167
Independent Pharmacies
3,318
Chain Pharmacies
5,485
Total Pharmacies
Want to compare to other states? Use map below:
The Number of Retail Pharmacies in 2024
The number of retail pharmacies varies across states and changes almost every year. The map below shows a
snapshot of the number of each state’s independent, chain, and total pharmacies in 2024.
