What Is a Pharmacy Benefit Manager?

America has a long history with prescription drugs, with nearly half the population reporting taking medication in the past month. But who really sets the rules and prices for prescription drug coverage? Enter the pharmacy benefit manager (PBM), a less-known yet highly influential player in the healthcare system. PBMs act as middlemen between health insurers and drug makers, influencing which drugs are covered and at what cost. As a patient, understanding the role of PBMs and their impact on your access to medications is crucial. And with PBMs covering more than 275 million Americans, it’s important to know who owns them and the pros and cons of their existence. In the ever-changing landscape of healthcare, it’s also worth exploring what the future holds for PBMs, such as the increasing coverage of biosimilars, which could potentially lower costs. As a patient, you may never directly interact with a PBM, but their decisions and policies can greatly affect your access to medication. Ultimately, by educating yourself on the role of PBMs and how to navigate the system, you can become a more informed and empowered advocate for your own healthcare.