In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. [1][2] PBMs operate inside of integrated healthcare systems (e.g.,...

Nov 15, 2022 · Pharmacy benefit managers (PBMs) help negotiate costs and payments between drug manufacturers, pharmacies, and healthcare insurance providers.

Jul 7, 2023 · At least nine bills introduced in Congress take aim at pharmacy benefit managers, the powerful middlemen that channel prescription drugs to patients. Here's what the fuss is all about.

Mar 17, 2025 · Pharmacy benefit managers, or PBMs, are companies that work with health insurers, large employers, and other payers to manage their prescription drug benefits. In the 1960s, when U.S. insurers began integrating prescription drug coverage into their plans, PBMs emerged to help set reimbursement rates, process claims, and pay pharmacies.

Mar 31, 2025 · The PBM business is part of CVS Health’s Health Services segment, which includes CVS Caremark, Cordavis, Oak Street Health, Signify Health, and MinuteClinic. For 2024, Express Scripts’ gain was CVS Caremark’s pain. Total PBM 30-day equivalent claims processed fell by −18.2%, from 2.3 billion in 2023 to 1.9 billion in 2024.

Jul 17, 2024 · The pharmacy benefit management (PBM) industry is a group of companies that serve as the middlemen between insurance companies, pharmacies, and drug manufacturers. PBMs are responsible for...

Mar 13, 2024 · From congressional hearings to political messaging efforts, pharmacy benefit managers (PBMs) have been at the center of recent drug pricing conversations. PBMs occupy a central role in the drug...

Jan 28, 2025 · Regarding the 3 major pharmacy benefit managers (PBMs) significantly controlling the US drug supply chain—CVS Caremark, Express Scripts, and Optum Rx—their concentration varied noticeably amongst commercial insurance, Medicare Part …

Oct 14, 2024 · PBMs establish networks of pharmacies preferred by their client health plans. They negotiate reimbursement rates for pharmacies, influencing where patients can fill their prescriptions and...

Pharmacy Benefit Managers (PBMs) help employers, health plans, and members manage the cost and access to prescription medications. Create and supply prescription medications to treat health conditions. Insurance providers that manage healthcare coverage, including prescription costs and access.