What is the primary role of a pharmaceutical benefit manager (PBM)?

The primary role of a pharmaceutical benefit manager (PBM) is to manage prescription drug benefits on behalf of health insurers or other payers. PBMs serve as intermediaries between insurers, pharmacies, and drug manufacturers, playing a crucial role in controlling costs and improving the efficiency of the healthcare system. By negotiating prices with drug manufacturers, managing formularies, and processing prescriptions, PBMs help to ensure that patients have access to necessary medications while also trying to keep overall drug spending in check for the health plans.

This role often encompasses evaluating the therapeutic effectiveness and cost-efficiency of medications, working to negotiate discounts and rebates from drug manufacturers, and establishing which drugs will be covered under various health insurance plans. This is essential in an environment where drug costs continue to rise, and the effective management of medication therapy is critical to improving health outcomes for patients.