Pharmacy Benefit Managers (PBM)

The cost of prescription medications in the United States is growing at a rate faster than physician and hospital costs combined, making it the fastest growing segment of personal healthcare costs. In 2015 prescription drug costs in the US represented nearly 17% of the overall cost of personal healthcare totaling approximately $457 billion. To help control employee prescription costs employers can use a Pharmacy Benefit Manager. A PBM functions similar to a TPA in helping to control costs, and negotiate claims, for prescription drugs. 

What can a PBM do for you?

Expert Advice

PBM's are knowledgeable about the prescription drug industry, it's their job. Having a good relationship with your PBM means you stay informed about industry changes relating to efficacy, pricing, and new or changing regulations.

Save Money

A PBM is essentially a TPA for your prescription drugs. They process claims, negotiate pricing, and offer cost saving options such as 90 day fulfillment, or mail order programs, to make sure your plan is getting the most bang for your buck.

Provide Insight

Your PBM will provide you with reporting similar to what your TPA provides. This reporting will contain information regarding drug utilization, trends, and money spent. This will allow you to make changes to your plan where necessary to save money.