What is a PBM?

Pharmacy Benefit Managers, often known simply as "PBMs," are largely unrecognized by most employees—and even by many employers. But they have a tremendous impact on U.S. health care decision-making. Three large companies—Express Scripts, CVSHealth and OptumRx—cover more than 180 million lives, or roughly 78% of the market, and while their role is largely unnoticed, employers and government entities must be vigilant as the non-transparent nature of the traditional PBM business model can add hidden costs and lead to higher prices.

Since 1987, when Advance PCS/Caremark (now CVSHealth) became the last of the original "big 3" PBMs to incorporate, the others being Medco and Express Scripts which merged in 2012, total prescription drug expenditures have skyrocketed 1010% and per capita expenditures have increased 756%.


The PBM Story:
What They Say, What They Do, and What Can Be Done About It