Pharmacy Benefit Management Case Study

1361 Words 6 Pages
Pharmacy benefit managers are third-party pharmaceutical benefit administrators. They’re primary functions are processing and paying for prescribed pharmaceutical drugs. They also secure contracts with pharmacies, create lists of preferred pharmaceuticals called formularies, and make deals with manufacturers. Utilization management programs are implemented by pharmaceutical benefit managers to assure that client treatment is necessary. Utilization management helps observe the medical need for and efficiency of provided care. For example, specialty drugs are very costly and can incur large amounts of money, but with utilization management programs in place, cost can be managed appropriately.
Pharmacy benefit management is largely used amongst employers to pay for prescription drug claims. Majority of employers offer their active employees prescription drug coverage. Half of employers offer their retired employees prescription drug coverage. The results of a survey released in June 2011 showed the top reasons employers offered pharmacy benefits to their employees (, 2011). Providing pharmacy drug coverage positively affects medical claims. It creates competition amongst other businesses. It also is a way of getting the attention of and retaining essential employees. Lastly it’s simply the right thing to do for employees. The cost to
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It’s more cost effective for them. There are a significantly high number of employers enrolled in pharmacy benefit managements, which causes them to be very financially successful. 70% of all drug prescriptions in the United States are processed by pharmacy benefit managers. There is only a small market of pharmacy benefit managers. Large portions of their profits come from drug manufacturer rebates and spread pricing (Rentmeester, C., & Garis, R.,

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