Industry brief: Pharmacy Benefit ManagersIf you have health insurance in the United States, you have probably run into the following problem: your doctor prescribes a drug, but your insurance company tells you it won't pay for it. You can, however, receive another drug that is judged to have similar properties. Sometimes the drug is a… Continue reading
Industry brief: Pharmacy Benefit Managers
If you have health insurance in the United States, you have probably run into the following problem: your doctor prescribes a drug, but your insurance company tells you it won't pay for it. You can, however, receive another drug that is judged to have similar properties. Sometimes the drug is a generic; sometimes it is just a different medicine from another major drug company. What drugs are accepted by your insurer is determined by what is called a formulary; the original drug was not included in the formulary.
In general, these formularies are determined by a set of companies called Pharmacy Benefit Managers (PBMs). These companies act as middlemen between drug companies