What is the primary function of a Pharmacy Benefit Manager (PBM)?

The primary function of a Pharmacy Benefit Manager (PBM) is to administer prescription drug benefits on behalf of health insurers or employers. This role involves managing the pharmacy benefit plans and helping to ensure that patients have access to necessary medications while managing costs effectively. PBMs negotiate with drug manufacturers for pricing discounts, create and maintain a formulary of covered medications, establish pharmacy networks, and process claims for prescription drug benefits.

This central role in managing pharmacy benefits helps streamline the process for patients, pharmacies, and insurers, enhancing medication access and affordability. The responsibilities of a PBM are critical in ensuring that the evolving landscape of prescription drug costs is effectively navigated, thereby supporting both patient needs and healthcare systems.