Without pharmacy benefit managers (PBMs), there would also be no utilization management tools to guide patients toward the safest, most cost-effective drugs, or to help reduce waste. Generic drugs, which are as safe and effective as brand drugs and a major cost saver for patients, would be used less often. When a PBM succeeds, patients save.
PBM value goes well beyond cost savings. PBMs carefully evaluate new drugs, review existing drugs, and apply sophisticated drug assessments that promote optimal use of complex medications and the appropriate use of mainstay drugs. Physicians and pharmacists employed by PBMs assist in managing drug-related side effects so that patients can stay on their drug regimens. That helps lower costs for patients and the entire healthcare system, and improves health outcomes for millions of people.
Greater transparency among all players in the prescription drug supply chain would help payers and consumers get the best value for their prescription drug dollar. For example, real-time benefit tools provided by PBMs inform doctors and patients, at the point-of-prescribing, where a medication is placed on a formulary and its out-of-pocket cost to that particular patient at that particular time. Supplying transparent information on the most affordable and clinically effective drugs for each patient enhances patient care and improves quality.