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.

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 prescription over 10 years.

RESEARCH SHOWS US

$962

PBMs save payers and patients an
average of $962 per person per year.

For every $1 spent on their services,
PBMs reduce costs by $10.

PBMs save payers and patients 40% to 50% on prescription drug and related medical costs, compared to what they would spend without PBMs.

PBMs AND YOU

How PBMs Work For You

  • Offer home delivery of medications and creating select networks of more affordable pharmacies.

  • Encourage the use of generics and more affordable brand medications.

  • Negotiate rebates from drug manufacturers and discounts from drugstores.

  • Manage high-cost specialty medications.

  • Reduce waste and improve adherence.

PBMs will help prevent 1 billion medication errors.

  • PBMs improve drug therapy and patient adherence in diabetes patients, annually helping to prevent
    • 480,000 heart failures
    • 30,000 incidents of kidney disease
    • 180,000 strokes
    • 8,000 amputations
  • 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.

Employers Discussing the Value of PBMs

Christopher Goff, CEO of Employers Health, an organization that helps plan sponsors deliver access to high-quality health benefits at a sustainable cost. Employers Health has more than 250 clients representing approximately 400 organizations in 34 states. In the video, Mr. Goff outlines how employers have the choice of selecting a pass-through or spread contracting when designing their prescription drug benefits.

Barry Sloane, CEO of Newtek Business Services, a business development company that helps small and mid-size businesses run their operations. In this video, Mr. Sloane discusses how PBMs help his company reduce costs and improve access to care.

9 in 10 Employers are Satisfied With Their PBM.

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

OnYourRxSide is an educational platform that provides critical information to help you learn more about prescription drug pricing and understand PBMs’ role in advocating for lower prescription drug costs and greater savings on necessary medications.

THE PHARMACY BENEFIT PODCAST

When PBMs Succeed You Save