Understanding Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) administer prescription-drug plans for people with third-party insurance—whether through a self-insured employer, health insurance plan, labor union, or government plan. More than 215 million Americans have prescription drug benefits administered through PBMs.
This module explains PBMs’ vital role in the pharmaceutical industry.
After completing this course, learners will be able to:
- Identify the key participants in the PBM industry
- Explain the services provided by PBMs to third-party payers
- Identify the key elements of pharmacy benefit design
- Describe the relationship between PBMs and pharmacies that participate in a PBM’s network
- Describe the relationship between PBMs and manufacturers of brand-name pharmaceuticals
- Distinguish between the roles of network retail pharmacies and PBM-owned mail pharmacies
- Delineate the sources of a PBM’s revenues and profits