Who Are Pharmacy Benefit Managers and What Do They Do?

Who Are Pharmacy Benefit Managers and What Do They Do? Pharmacy benefits managers (PBMs) are companies or third-party administrators of prescription medication programs for health insurers, Medicare Part D drug plans, and employers. They develop and maintain the list of medicines, known as formulary, negotiate discounts with drug manufacturers and process prescription claims. PBMs handle price negotiations, distribution of prescription medications and insurance claims for health insurance providers. They have a significant impact on determining the total medication costs for the insurers.

Claw backs by PBMs Insurers usually have to pay a fixed amount as copay for medications. PBMs make formularies to help the enrollees save on meds by structuring the formulary in tiers in a way that the consumers have to copay a low amount for the medications placed in the preferred tier and a higher amount for high tier, specialty and branded medications. At times, the insurance copayment for some particular medication may be higher than its cash retail price, and the PBM claw backs the difference of cash price and formulary list price in the process, as the pharmacies are prohibited to tell the consumer about the possibility of buying the medication at a lower price unless they directly ask about it.

Additionally, PBMs do the following:  Develop of list of covered medications in the formulary that determines the out-ofpocket expenses for the consumers.  Use their purchasing power to negotiate discounts on medicines.  Directly contact the pharmacies to reimburse for the supply and dispensing of medications.

PBMs help in reducing medications’ costs as they encourage the use of generics and more affordable or preferred brand-name medications. They create a select network of more affordable pharmacies and ménage high-cost specialty medications.

PBMs are incentivized for favoring high-priced medications as their rebates are usually calculated as a percentage of the manufacturer’s list price. They receive larger rebates for highpriced medicines than the ones that provide better value at a lower cost. As a result, the consumers, especially those in high deductible health plans may have to pay more as the outof-pocket expenses in the form of copays.

Spread pricing There is a controversy surrounding the PBM practice of “spread pricing” wherein they are reimbursed a higher price for the generic drugs by the health insurance providers that what they actually pay to the pharmacies. This happens due to the lack of transparency in the payment schedule of PBMs. PBMs operate inside of integrated healthcare systems such as Veterans Health Administration, to reduce the pharmacy expenses and help the users save on prescription medications. Though there are around 50 PBMs currently operating in the USA, three topmost of them Express Scripts, Caremark and OptumRx comprise 80% of the market share, covering 180 million enrollees.[1] PBMs look for more rebates Americans buying insurance need to carefully evaluate their covered medications and out-ofpocket expenses as their costs of treatment could soar despite insurance as PBMs work to gain more rebates from your plans through the placement of medications in specific tiers, high deductibles, copays and coinsurances. So, it makes sense to use a drug discount card, such as EzRx drug card which is offered free of cost to all without any restrictions of age, income or insurance coverage.

Download your drug discount card for free EzRx prescription savings card can be used to save on prescription drugs at over 65,000 network pharmacies of up to 85% on prescription medications in the best-case scenarios. Download your free prescription cost savings card from www.ezrxdrugcard.com and show it to your pharmacist to get your medications at the discounted price as it is provided activated. No registration or disclosure of personal information such as your health condition, income or age is needed. There are no upfront costs or renewal charges either.

Save on medication costs with insurance EzRx drug card can be used to save on medication costs with insurance as it works independently of insurance and can be used instead of your health insurance because you may find many medications at a lower price with EzRx prescription cost savings card compared to your insurance’s copays or formulary tier price.

Check drug prices at www.ezrxdrugcard.com for the lowest price by simply putting the name of the medication and your zip code in the search, and watch as the results start coming in from the nearby local pharmacies and big chains such as CVS, Winn Dixie, Rite Aid, Kroger, including the supermarkets such as Walmart, Safeway, Walgreens, and more.

To get your digital drug savings card, text the keyword “EZRX” to the phone number 21000. You can also use your EzRx drug card as flu vaccine discount card, Albuterol drug discount card, Adipex discount card, or to save on meds that you need to treat your various health conditions.

The card can also be shared with friends, family and colleagues to help them in medication savings and improve adherence to the treatment.

Reference https://en.wikipedia.org/wiki/Pharmacy_benefit_management