What is the main purpose of pharmacy benefit management?

The primary purpose of pharmacy benefit management is to manage drug programs and control costs effectively. Pharmacy benefit managers (PBMs) play a crucial role in the healthcare system by acting as intermediaries between insurance providers, pharmacies, and pharmaceutical companies. They develop and maintain drug formularies, negotiate prices and rebates for medications, and establish cost-sharing mechanisms. This is essential in ensuring patients have access to necessary medications while also managing the overall costs associated with prescription drugs for insurers and employers.

Through various strategies such as utilization review, prior authorization requirements, and tiered co-pays, PBMs help to ensure that medication is prescribed in the most economical way and is both clinically effective and affordable. This cost-control mechanism is vital in a healthcare system where the rising costs of medication can significantly impact both patients and providers.