This rebate system, as well as the revelation that PBMs around the country are profiting hundreds of millions of dollars on Medicaid programs, has put PBMs in the middle of a PR nightmare. (Photo: Getty)
“Eliminate the middleman.” This has become the mantra for reducing prices of prescription medication, but many consumers find themselves wondering just who is the middleman?
In the prescription medication universe, pharmacy benefit managers (PBMs) act as go-betweens for insurers, drug makers and pharmacies, with the supposed goal of controlling drug utilization and cost. These PBMs are the entities primarily responsible for producing health formularies, the lists of prescription drugs covered in part or in full for insurance enrollees. As formulary coverage could mean the difference between financial security or ruin, PBMs are rightfully coming under increasing scrutiny.
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