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.