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The Patient Journey: See How PBMs Coordinate Your Health Care

Why PBMs?

Pharmacy Benefit Managers (PBMs) increase access and lower Rx costs for 266 million patients with health coverage provided by commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.

The results are better health outcomes and greater patient savings.

01

On average, PBMs save patients and health plans $123 per brand prescription.

02

PBMs have reduced prescription drug costs to help more than 266 million Americans access safe, affordable medications.

03

PBMs save patients and payers an average of $962 per person, per year.

04

PBMs achieve savings by driving competition for more generic medications. According to the U.S. Federal Trade Commission (FTC), competition is more likely to increase transparency among drug manufacturers than regulations attempting to force companies to disclose how prices are determined.

05

Over the next 10 years, PBMs will help prevent one billion medication errors by reviewing newly prescribed drugs, checking for possible drug interactions, and alerting pharmacies and doctors of potential risks.

06

PBMs improve drug therapy and help patients take their medications properly. For patients with diabetes, PBMs help prevent more than 480,000 heart failures, 230,000 cases of kidney disease, 180,000 strokes, and 8,000 amputations every year.

Help Control Prescription Drug Price Hikes

Pharmacy Benefit Managers (PBMs) are your advocates in the health care system, working to reduce prescription drug costs for patients across the country.

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Research Confirms PBMs' Value

Independent studies prove that PBMs deliver cost savings and better medication access for consumers.

Rebates

  • PBMs reduce prescription drug costs by negotiating rebates with drug makers and passing some of the savings to patients and payers, obtaining drug price discounts from retail pharmacies and dispensing drugs at lower costs through mail-order pharmacies.

  • Research has found no link between the prices prescription drug manufacturers set and the rebates negotiated for patients and payers by PBMs.

  • Despite significant increases in insulin costs, there is no correlation between the growing prices set by drug makers and the rebates advocated by PBMs.

Value

  • PBM services provide significant savings for patients and payers, helping reduce prescription drug costs for more than 266 million Americans.

  • PBMs achieve cost-savings by encouraging competition for more generic medications. This has the added benefit of increasing transparency. Research has shown that competition, rather than regulation, is more likely to improve transparency.  

Advocacy

  • PBMs are critical to delivering high-quality, cost-effective health care. They achieve savings for patients and payers by negotiating discounts with drug manufacturers and encouraging the use of low-cost generics and affordable brands.

  • Last year, spending was reduced by 28% and average patient out-of-pocket costs declined as a result of the discounts, rebates, and other price reductions negotiated by PBMs on brand drugs.

  • PBM advocacy achieved medical cost savings for patients and payers through list price reduction of 35%, and 46-69% reduction in net costs for Medicare Part D Plans across 12 widely used therapy classes.

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