Pharmacy Benefit Managers (PBM)

Pharmacy Benefit Managers (PBMs) act as intermediaries between insurance companies, pharmacies, and drug manufacturers. Their main role is to manage prescription drug benefits for health plans, helping to negotiate prices, determine formularies (which drugs are covered), and streamline the claims process. By leveraging their buying power, PBMs aim to reduce costs for both insurers and consumers. They also implement various programs to promote the use of less expensive or more effective medications. However, their practices have come under scrutiny for issues related to transparency and the overall impact on drug prices.