Back to Basics: What is a PBM?

Pharmacy benefit managers help employers provide and manage their pharmacy benefits for employees while honoring their bottom line. What does that mean, exactly? Today we are going back to the basics and will answer some common questions about what PBMs do.

What is a pharmacy benefit manager (PBM)?

A PBM contracts directly with a company and works on their (and their employees’) behalf as administrators of their prescription drug benefits. The PBM negotiates pricing and administers discounts and rebates, processes and pays prescription drug claims, develops pharmacy networks, maintains contract relationships with pharmacies, and develops and updates the drug formulary.

PBMs help make the process easier for employers. A dependable PBM will ensure employees have the benefits they need while considering the company’s bottom line.

There are generally three types of customers that hire PBMs to manage their pharmacy benefits plan:

  • Employers
  • Brokers and third party administrators
  • PBM consultants

What do companies need to consider when choosing a PBM?

When choosing a PBM to manage your pharmacy benefits plan, we recommend doing thorough research to ensure you are working with a partner, not just another vendor. A true partner will keep you and your employees’ best interests in mind.

A few questions to consider when choosing a PBM partner:

  • How much will the PBM make to manage your plan, and how is their revenue generated?
  • Is their revenue based on any form of spread pricing and partial rebate share?
  • What is the true impact of rebates on overall spend?
  • What are their recommendations for controlling pharmacy costs?
  • How do they manage high-cost specialty medications?
  • How will they add value to your pharmacy benefits plan?
  • How will they support your administrative team and employees?

The answers to these questions will give you an idea if they are a transparent, pass-through PBM or if you should consider continuing your search.

Transparent, pass-through PBMs

What does it mean to be a truly transparent and pass-through PBM? Transparent, pass-through PBMs receive zero revenue from spread pricing, rebates, or hidden revenue streams, which ensures that they have zero incentive to drive utilization based on undisclosed revenue generation. This allows the PBM to simply focus on providing the most efficient and cost-effective treatment for members with the highest possible member adherence to high-cost medications. MaxCare passes all cost savings to the plan. We are a proven PBM partner who focuses on the needs of both the plan and the member while delivering the lowest overall pharmacy cost.

We often talk about the MaxCare difference, and not only are we a transparent and pass-through PBM, but we also take pride in providing personalized service, streamlined systems, and a collaborative team environment. We are here for you!

Proudly helping clients since 1985

MaxCare has been providing pharmacy benefits for plans throughout the United States since 1985 and we would love to provide our services to you.

Ready to learn more about the MaxCare difference? Contact us today!

More To Explore

Stay Informed with MaxCare

Subscribe to our newsletter for regular updates, industry news, and exclusive content. Stay ahead with expert insights, special offers, and helpful resources.