Which services are provided by a pharmacy benefit management company (PBM)?

Which services are provided by a pharmacy benefit management company (PBM)?

• A. Only handling mail order services.
• B. Pharmacy claims processing, rebate negotiations, formulary management, drug utilization reviews, and disease management programs.
• C. Owns all client pharmacies in the network.
• D. Manufactures prescription drugs.

Answer: (B)

A PBM acts as an intermediary that manages prescription drug benefits for payors, coordinating how drugs are accessed, paid for, and used. The key services shown—processing pharmacy claims, negotiating rebates with drug manufacturers to lower net costs, managing formularies to determine which drugs are preferred or covered, performing drug utilization reviews to ensure appropriate and safe use, and running disease management programs to improve outcomes—all illustrate the core ways a PBM reduces costs and optimizes care for a population. Other choices don’t fit because they describe functions that aren’t the primary scope of PBMs: mail-order capabilities can be part of a PBM’s offerings but aren’t the sole service; PBMs don’t own client pharmacies; and they don’t manufacture prescription drugs.

A PBM acts as an intermediary that manages prescription drug benefits for payors, coordinating how drugs are accessed, paid for, and used. The key services shown—processing pharmacy claims, negotiating rebates with drug manufacturers to lower net costs, managing formularies to determine which drugs are preferred or covered, performing drug utilization reviews to ensure appropriate and safe use, and running disease management programs to improve outcomes—all illustrate the core ways a PBM reduces costs and optimizes care for a population.

Other choices don’t fit because they describe functions that aren’t the primary scope of PBMs: mail-order capabilities can be part of a PBM’s offerings but aren’t the sole service; PBMs don’t own client pharmacies; and they don’t manufacture prescription drugs.