Understanding the Role of Pharmacy Benefit Managers in Healthcare
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.
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