The Driver Dictating Prescription Drug Benefits: PBMs Explained

Pharmacy benefit managers — liaisons between pharmaceutical companies and health insurers that run patients’ prescription benefits — are one focal point in the debate over why drug prices are so high in the U.S.

PBMs initially were formed in 1968 to process claims and negotiate lower prices with drugmakers. Now, PBMs administer prescription drug plans for more than 266 million Americans who have health insurance.

The Federal Trade Commission is expected to probe the PBM industry this year about the fairness of their reimbursement policies.

1. What do PBMs do?

PBMs manage patient drug benefits for health insurers, large employers, ...