Question

What is a PBM?

Answer

PBM stands for pharmacy benefit manager. A PBM is a company that manages the prescription drug (pharmacy) component of an employer's or other sponsor's healthcare benefits. (These benefits often include medical, dental, and vision benefits along with pharmacy benefits.)

PBMs manage the pharmacy benefit for a client by controlling the administrative costs of processing prescription drug insurance claims and using clinical programs to ensure the right medications are prescribed for the right conditions. Clinical programs - including care management programs - help the PBMs' clients provide appropriate and preventive healthcare to the people covered under their pharmacy benefit. (Care management programs are targeted to persons living with certain health conditions - such as diabetes, high cholesterol, and heart disease.)

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