Please wait while loading...


Understanding the Role of Pharmacy Benefit Managers in Healthcare

October 2022
Full report

Pharmacy benefit managers (PBMs) positively contribute to overall member health and fulfill a critical role in the healthcare system. PBMs increase access to safe and effective medications for individuals while simultaneously reducing drug spending and costs. 

PBMs manage the prescription drug portion of the health benefit for more than 266 million Americans. This includes individuals who are enrolled in commercial, government-sponsored, and employer group health plans. PBMs add value in three primary ways: improving health outcomes using evidence-based clinical programs, designing effective pharmacy networks, and reducing prescription drug spending and costs. 

Successful administration of the prescription drug benefit requires weaving together these strategies in a way that is customized for each population; this can include formulary management, digital tools, and value-based payment models. This paper explores how PBMs enhance member outcomes and deliver economic value to the healthcare system. 


  • The Role of PBMs
  • PBMs’ Clinical Programs
  • Pharmacy Network Design and Management 
  • Strategies to Reduce Drug Costs

Related Public Policy Research

Approaches to the Medicaid Prescription Drug Benefit
March 2022
States that employ Medicaid managed care organizations (MCOs) to pay for prescription drugs outperform states that rely on the fee-for-service (FFS) setting to control drug costs. 
Addressing the Opioid Epidemic through Prevention, Treatment and Recovery, and Deterrence
September 2019
Elevance Health partners with policymakers, consumers, care providers, law enforcement, and others to promote prevention, improve treatment and recovery, and deter potentially harmful behavior.