Pharmacy benefit managers (PBMs) administer prescription drug plans for hundreds of millions of Americans who have health insurance from a variety of plan sponsors, including commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, federal and state government employee plans, managed Medicaid plans and others.
Plan sponsors recognize the value that PBMs provide and view PBMs as trusted partners to help manage drug costs and improve care for their beneficiaries. Given the combined membership of the plan sponsors they service, PBMs are able to effectively negotiate rebates from drug manufacturers to help lower net costs for plan sponsors. This is especially important in an era of rising pharmaceutical costs.
PBMs also reduce drug costs by encouraging the use of low-cost generic drugs where clinically appropriate and offering programs to help drive medication adherence, which improves health outcomes and saves the health system up to $300 billion in health care costs annually.
According to the Pharmaceutical Care Management Association (PCMA), the scale and clinical expertise that PBMs provide is projected to save employers, unions, government programs and consumers $654 billion – up to 30 percent – on drug benefit costs over the next decade. PBMs will continue to play a crucial role in achieving savings for their plan sponsors and beneficiaries and driving efficiencies in the health care system.