Pbms

Auditors estimate that three to ten percent of pharmacy benefit management (PBM) claims are processed incorrectly — always in favor of the PBM (Care Magazine). As an introduced solution to the rising costs of employer-provided healthcare, pharmacy benefit management is a method that has sought to alleviate the rising costs of prescription drugs by working for both pharmaceutical companies and employers to provide the most cost-effective solutions for healthcare provision. However, with decreased competition and increased opportunities to reap excessive profits from employers, PBMs have instead clouded the market for prescription drugs rather than combating the social issue of unaffordable healthcare provision. In a pursuit for high profits, PBMs do not provide employers with enough information regarding their revenue contracts with pharmaceutical companies; thus, there is sufficient evidence to conclude that PBMs may not always be acting in the best interests of the consumers. This essay will first explain the role and efficiency that arises from a third party or middleman in the employer provision of healthcare, and will follow up with refinements that employers should implement in order to further combat the issue of the rising costs of prescription drugs, thereby allowing employers to provide healthcare at a socially just and affordable cost.
Pharmacy benefit managers today have over two hundred million Americans as beneficiaries including sixty-five percent of the country’s seniors (AIS). This solution, implemented in the late 1980s, provided both employers and pharmaceutical companies a much more efficient and cost-effective method of healthcare provision to employees in the United States. PBMs supply prescription drugs at reduced prices to their clients’ employees. They draw up drug formularies, analyze clinical-trials data, and bargain with pharmaceutical companies, offering to deliver all their business to one company in exchange for a discount. However,... [continues]

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