Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs .

1. PBMs REDUCING
DRUG PRICES
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2. Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS
programs with goals to lower prescription drug costs, improve convenience, and ensure patient safety for payers and their benefi-
ciaries. PBMs may provide significant advantages to payers looking to lower prescription drug prices. Payers in both private and
public sectors require new strategies that offset rising cost of prescription drugs. As healthcare payers seek effective ways to
manage high prescription prices, PBMs can maximize the Return on Investment while improving beneficiary satisfaction.
PBMs reduce prescription drug costs and improve quality for patients, employers, unions, and government programs by:
Engaging patients to make better health decisions and
maximize the use of their benefits
Encouraging the use of generics and more affordable
brand medications
Supporting healthcare providers through
evidence-based care support and improving patient
adherence to their treatment plans
Assisting physicians in managing increasingly complex
medication regimens and patient populations
Partnering with specialty pharmacies to support patient
safety, reduce errors, and improve the lives of patients
PBMs want the same thing their clients and consumers want: lower drug prices. Which is why PBMs promote generics over
brands whenever possible. The large, sophisticated purchasers who hire PBMs—Fortune 500 companies, major labor unions, and
plans in government programs like Medicare Part D—offer performance incentives to reduce overall pharmacy costs. Those
incentives are outweighed by rebate on drugs, almost all of which are passed back to payers. The bottom line is that the best
antidote to higher prices is more competition. The FDA could facilitate this by approving generics, brands, and bio-similar competi-
tors faster so they could get to market quickly.
As policymakers explore new ways to make prescription drugs more affordable, they should build on the proven success of PBMs
and explore new policies to increase the single, most powerful force for reducing drug costs: More Competition.
Focusing on clinical outcomes, their corresponding
economic savings, and value-based pricing
Offering low cost pharmacy plans that offer convenient
access (such as home delivery) and extra discounts at
certain pharmacies
Negotiating rebates and discounts from drug manufac-
turers and drugstores and fostering competition
Managing specialty medications billed under both the
pharmacy and medical benefits
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Pharmacy Benefit Managers:
Part of the solution to high drug prices

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Conclusion
With a lot of broken pieces to be fixed, PBMs are surely
the ones that need to streamline things and make sure
drug prices are lowered while the quality is maintained.
Fostering competition might be one of the routes to
make sure manufacturers are not over pricing. Until that
happens at national scale, Surescripts’ real time data
integration is something to look at. Having EHRs and
Patient Portals integrate with the tool pulling informa-
tion around the bio-similars, generics and the pricing of
these, will complement the doctors in prescribing
better/economic medications and also help the patients
choose the one with the lowest prices. As the system
strives to deliver on the “Triple Aim” — lower cost, better
health, and improved patient experiences — building
applications to educate patients about drugs and coordi-
nating their care, assisting providers/patients choose the
best drug are some of the ways to save the lost dollars in
drugs and help patients administer their medications in
a more efficient way. We would love to share our inputs
and understand your thoughts around this and possibly
come to a meaningful solution to this challenge that is
the primary focus of the CMS today!