5 December 2023 - Pharmacy benefit managers (PBMs) manage prescription drug benefits on behalf of health insurers; PBMs negotiate reimbursements for drugs, which should cover drug acquisition cost and pharmacy’s cost to dispense. 

Studies in Medicaid suggest that some PBMs pay pharmacies unjustified excessive amounts for generics, as high as 10 times acquisition costs. By inflating the amount paid to pharmacies, PBMs make patients pay more because patient cost sharing is based on point of sale reimbursement.

Read JAMA article