An organization that provides programs and services designed to help maximize drug effectiveness and contain drug expenditures by influencing the behaviors of prescribing physicians, pharmacists, and members.
A specialty health care organization that serves thousands of client groups, including managed care companies, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. These organizations specialize in pharmaceuticals and strive to contain the costs of prescription drugs while promoting more efficient, safer drug use.
PBMs are third party administrators of prescription drug benefits.
Companies that contract with Medicare Advantage Organizations to manage pharmacy services. The Secure Health Pharmacy Benefit Manager is Walgreens Health Initiative (WHI).
An organization that provides administrative services in processing and analyzing prescription claims for pharmacy benefit and coverage programs. PBM services can include contracting with a network of pharmacies; establishing payment levels for provider pharmacies; negotiating rebate arrangements; developing and managing formularies, preferred drug lists, and prior authorization programs; maintaining patient compliance programs; performing drug utilization review; and operating disease management programs. Many PBMs also operate mail order pharmacies or have arrangements to include prescription availability through mail order pharmacies. PBMs are expected to play a key role in managing pharmacy benefit plans in the Medicare drug program.
A entity that supplies a network of member pharmacies to a health plan and manages the prescription claims to control cost.
A pharmacy benefit manager (PBM) is a third party administrator of a prescription drug program that is primarily responsible for processing and paying prescription drug claims. Technically, PBMs are private firms that contract with employers, insurers and public and private plan sponsors, but HMOs, managed care organizations, state governments, etc. also can function as PBMs.