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Pharmacy benefit management companies

R Taniguchi1

  • 1Kaiser Permanente, Aiea, HI 96701, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|September 1, 1995
PubMed
Summary
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Pharmacy benefit management (PBM) companies offer services to control costs and improve access to medications for employers and insurers. They manage pharmacy benefits through various strategies, including formularies and mail-order services.

Area of Science:

  • Health Services Research
  • Pharmaceutical Policy

Background:

  • Pharmacy benefit management (PBM) companies are integral to the healthcare system, contracting with employers and insurers.
  • PBM organizational structures and services vary due to their diverse business origins.

Purpose of the Study:

  • To describe the principal services offered by pharmacy benefit management (PBM) companies.
  • To elucidate the role of PBMs in providing accessible and cost-effective pharmacy benefits.

Main Methods:

  • The study describes the functions of PBMs based on their common service offerings.
  • Analysis includes PBMs that provide services directly (e.g., mail order) and those that subcontract.

Main Results:

  • Full-service PBMs establish pharmacy networks, process claims electronically, and manage drug utilization.

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  • Key functions include promoting generic drugs, managing formularies, negotiating rebates, and conducting drug-use reviews.
  • PBMs develop disease management programs and evaluate patient outcomes by integrating therapy data with overall care information.

    • Conclusions:

    • PBMs play a crucial role in managing pharmacy benefits through a comprehensive suite of services.
    • Their activities aim to enhance medication accessibility and cost-effectiveness for plan members.
    • Data utilization and disease management are key components of modern PBM operations.