Why PBMs?

Pharmacy Benefit Managers (PBMs) are working to lower prescription drug costs for consumers, employers, government programs, and unions.
When they succeed, patients save.

PBMs manage prescription drug plans for millions of Americans who have health insurance, such as union health plans, commercial insurance plans, and managed Medicaid plans.

PBMs are your advocates, negotiating with drug manufacturers and pharmacies for lower prescription drug prices and higher quality. PBMs negotiate with drug makers and pharmacies to lower costs by encouraging competition, promoting access to generic drugs, and securing rebates and discounts for patients and payers.

The results are better health outcomes and greater patient savings.

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

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

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PBMs save patients and payers an average of $941 per person, per year.

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PBMs reduce costs by $6 for every $1 spent on their services.

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PBMs save patients and payers 40-50% on annual prescription drug and related medical costs, compared to what they would spend without PBMs.

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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.

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The FTC found that state-based disclosure mandates may raise the costs of providing pharmacy benefits because of a risk of reduced competition or even collusion among drug makers.

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PBMs achieve Medicare Part D cost savings of 58% and premium savings of 66%.

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Over the next 10 years, PBMs will help prevent 1 billion medication errors by reviewing newly prescribed drugs, checking for possible drug interactions, and alerting pharmacies and doctors of potential risks.

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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.

How PBMs Save Consumers Money

As the costs and use of prescription drugs continue to rise, Pharmacy Benefit Managers (PBMs) work hard to find cost savings wherever possible. PBMs use a variety of strategies to reduce out-of-control prescription drug prices.

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Pharmacy Networks

PBMs build networks of pharmacies that compete on service, convenience, and quality to attract consumers in a particular health plan. This competition keeps prescription drug costs down.

Home Delivery of Drugs

Health plans and employers offer their members and employees less expensive prescriptions for 90-day supplies of medications when they choose home delivery. Mail-service pharmacies can offer lower prescription drug prices because they have lower overhead costs and are often more efficient than other types of pharmacies.

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Generic Drug Use

PBMs help save money by using innovative management tools to increase the use of generic drugs, which are as safe, but less expensive than name brands.

Drug Price Negotiations and Rebates

PBMs help rein in out-of-control prescription drug prices by negotiating price discounts and rebates from pharmacies and drug manufacturers.

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Help control prescription drug price hikes.

Pharmacy Benefit Managers (PBMs) are your advocates in the health care system, working to lower out-of-control prescription drug prices for patients across the country.

GET INVOLVED!

Research Confirms PBM 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.

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

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

Value

  • PBM services provide significant savings for patients and payers and will help 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.  

  • Medicare Part D beneficiaries receive 100 percent of the savings PBMs negotiate on their behalf; but disclosing drug-pricing information could increase the cost of Medicare prescription drug benefits by billions of dollars and facilitate collusion among drug makers.

Advocacy

  • PBMs are critical to delivering high-quality, cost-effective healthcare. 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 percent 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 percent, and 46-69 percent reduction in net costs for Medicare Part D Plans across 12 widely used therapy classes.