How pharmacy benefit managers deliver results

An exceptional pharmacy benefit manager (PBM) partner will provide value that aligns with your goals while lowering drug costs, creating better employee and provider experiences and driving better health outcomes.


Comprehensive value

To choose a PBM that’s a good fit for your employees, it’s important to consider four key areas in which your PBM should be delivering results.

Managing specialty

With soaring specialty costs come new challenges, which is why it’s crucial to focus on employee health outcomes and integrated care.

Questions to consider:

  • Can your PBM show results that reduce hospitalization rates and ER visits and lower total net cost per member per month?
  • What is your PBM doing to manage new higher-cost drugs and promote highly effective alternatives?
  • When your employees need specialty medications, are they able to choose a pharmacy that’s not owned by your PBM?


Lowering drug costs

Total drug management — including robust formulary management and strategies to help mitigate rising specialty costs — is key to controlling your overall costs.

Questions to consider:

  • How does your PBM manage drugs to help drive to the lowest total cost for you and your employees?
  • Is your PBM proactively pursuing strategies for generics and biosimilars to help you and your employees save money?
  • Has your PBM shared which drugs will be coming out soon to help you plan for and anticipate costs across your medical and pharmacy benefit?
  • Has your PBM effectively managed changes that impact your employees?

Optimizing access

Finding information and accessing medications can be overwhelming. Your employees deserve to get their medications in the ways they prefer and at the best available cost.

Questions to consider:

  • Does your PBM work with you to steer employees to the most affordable pharmacy outlet?
  • Does your PBM work with you to help find the most affordable option for your employees?
  • What ongoing support does your PBM offer to help your employees achieve the best possible outcomes?

Improving medication adherence

It’s crucial that your PBM offers clinical programs to improve medication adherence, help eliminate gaps in care and deliver a connected experience from beginning to end.

Questions to consider:

  • Does your PBM help remove barriers to adherence by providing your employees with easy access to their medications?
  • Does your PBM partner with physicians to engage your employees directly and help them keep taking the medications they need?
  • Will your PBM automatically extend previous drug authorizations and notify your employees of their continued access to their medications?

Simplifying PBM pricing

The bidding and contracting process is complex. Understanding PBM pricing concepts can help you choose a PBM that will provide you and your employees the greatest overall value.