THE VALUE
OF PBMs

PBMs are Committed to Helping Patients

Pharmacy Benefit Managers (PBMs) are your advocates in the health care system, working to lower prescription drug costs for patients and payers across the country.

PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, managed Medicaid plans, and others. PBMs will save health plan sponsors and consumers more than $1 trillion on prescriptions over 10 years.

Over the next 10 years, PBMs will help prevent 1 billion medication errors.

PBMs improve drug therapy and patient adherence in diabetes patients, helping to prevent some 480,000 heart failures, 230,000 incidents of kidney disease, 180,000 strokes, and 8,000 amputations annually.

In addition, through specialty pharmacy services, PBMs will help extend and improve the quality of life for patients with multiple sclerosis and rheumatoid arthritis by approximately 1 million Quality Adjusted Life Years (QALYs) over 10 years.

PBMs originated more than two decades ago

Today, health care plans hire PBMs to secure lower costs for prescription drugs, passing the savings directly to patients. PBMs are your first line of defense against rising prescription drug costs. They work to ensure lower costs and better health outcomes through affordable access to medicines you need.

HOW PBMs WORK FOR YOU

Virtually all – 99.6% of prescription drug rebates PBMs negotiated with drug manufacturers in Medicare Part D are passed through to drug plan sponsors and used to lower costs for Medicare beneficiaries, according to the U.S. Government Accountability Office (GAO).

The vast majority of employers
say that PBM programs are
effective at reducing drug costs
for their organization.

When PBMs
Succeed You Save

  • PBMs offer home delivery of medications and creating select networks of more affordable pharmacies.
  • PBMs encourage the use of generics and more affordable brand medications.
  • PBMs negotiate rebates from drug manufacturers and discounts from drugstores.
  • PBMs manage high-cost specialty medications.
  • PBMs reduce waste and improve adherence.
  • More than 9 in 10 employers are satisfied with their PBM.
  • According to a poll of employers, over four-fifths say their company’s contract with its PBM is transparent.