Unveiling the Role of Pharmacy Benefit Managers (P.B.M.s)

A Closer Look at Pharmacy Benefit Managers (P.B.M.s)

Americans often find themselves grappling with the issue of overpriced prescription drugs, pointing fingers at drug companies, insurers, and a malfunctioning federal government. However, there is a group of influential entities that often go unnoticed, operating within the intricacies of the healthcare system and shrouded in complexity – the pharmacy benefit managers (P.B.M.s).

The three largest P.B.M.s manage prescriptions for over 200 million Americans, acting as intermediaries in the healthcare landscape. These P.B.M.s, owned by major health conglomerates such as CVS Health, Cigna, and UnitedHealth Group, are engaged by employers and government bodies to oversee prescription drug coverage.

While the primary goal of P.B.M.s is to lower drug costs, they often have the opposite effect. They tend to steer patients towards more expensive medications, impose significant markups on affordable drugs, and accrue substantial undisclosed fees, as revealed by a recent investigative report by The New York Times.

For most Americans, health insurance is typically provided through either a government program like Medicare or an employer. Each individual is covered by two distinct types of insurance – one for medical services and the other for prescriptions. The latter is where P.B.M.s come into play, managing the drug coverage aspect.