How Pharmacy Benefit Managers and Payers Collaborate to Reduce Costs
As prescription drug spending rises in the United States, healthcare stakeholders and policymakers constantly look for ways to curb costs. Many payers turn to pharmacy benefit managers (PBMs), which aim to negotiate lower drug prices with pharmaceutical manufacturers.
PBMs are third-party entities that act as intermediaries between health insurers and drug companies. PBMs manage prescription drug benefits for commercial health plans, self-insured employer plans, Medicare Part D plans, and Medicaid managed care organization plans. They are tasked with negotiating rebates and discounts with manufacturers, creating formularies, establishing pharmacy networks, and processing claims.