Posted by Michael Wonder on 12 Apr 2017
Pharmacy benefit management companies: do they create value in the US health care system?
12 April 2017 - Pharmacy benefit management companies perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations.
By aggregating lives covered under their many individual contracts with payers, Pharmacy benefit management companies (PBMs) have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan’s drug benefit, and create competition among providers for inclusion in a plan’s network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing.
Whether these potential outcomes are realised within the relevant budget is a function of the healthcare system and the interaction of benefit design and clinical processes—not just individually vetted components.
