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PBM P&T Practices: The HEAT Initiative Is Gaining Momentum
Summary
Government investigations scrutinize the pharmacy benefit management (PBM) industry
Area of Science:
- Health Economics
- Pharmaceutical Policy
Background:
- The pharmacy benefit management (PBM) industry faces intense government scrutiny regarding high drug costs.
- Practices related to P&T committees and formularies are central to these investigations.
Purpose of the Study:
- To analyze the pharmacy benefit management (PBM)-based P&T and formulary practices.
- To understand the specific aspects of PBM operations under government investigation for pharmaceutical pricing.
Main Methods:
- Review of PBM operational models.
- Analysis of P&T committee structures and functions.
- Examination of formulary design and management strategies.
Main Results:
- Identification of key PBM practices influencing drug costs.
- Assessment of the role of P&T committees in formulary decisions.
- Evaluation of formulary tiering and restrictions.
Conclusions:
- PBM practices, particularly P&T and formulary management, are critical factors in pharmaceutical cost discussions.
- Further examination of PBM operations is warranted to address concerns about drug pricing.
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