With the public debate about prescription drug prices playing out in the press, in Congress, and among regulators, policymakers are focusing on the role of pharmacy benefit managers (PBMs) in addressing drug costs.
Operating under contract with health plan sponsors – insurers and self-funded employer plans alike – PBMs work to lower prescription drug costs for patients. In addition to their role negotiating lower drug costs with manufacturers and pharmacies, PBMs also monitor the drug development pipeline for new therapies, and through their affiliated mail service and specialty pharmacies, provide safe, convenient, and less expensive home-delivered medications for patients. During the COVID-19 pandemic, PBMs facilitated ready access to mail delivery of needed medications for those trying to stay safe, encouraged and facilitated health plan enrollee COVID vaccination, and supported efforts to identify and help address health care disparities.
