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Pharmacy benefit management. In the United States, a pharmacy benefit manager ( PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
Three companies controlled 79% of U.S. pharmacy benefit management in 2022, according to the data platform Statista: CVS Caremark with 33%, Express Scripts at 24%, and OptumRx owns 22% of the market.
Pharmacy benefit management — working with employers, health plans companies and government programs — dominate the specialty pharmacy market in the United States since at 2008. According to the American Pharmacists Association (APhA), "Historically, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug ...
The Pharmaceutical Care Management Association (PCMA) is an American national trade association representing pharmacy benefit managers.According to the association's mission statement, PCMA advocates on behalf of its member companies, which claim to improve affordability of prescription drugs and quality of care through the use of tools such as electronic prescribing (e-prescribing), promoting ...
The three biggest pharmacy benefit managers excluded 1,356 medications for at least a year from 2019 to 2022, according to a Pembroke Consulting study. Prior authorization, step therapy and exclusions
CVS Caremark has been aggressively trying to grow its pharmacy-benefits-management business after suffering from some major setbacks in 2009-2010. High-profile contracts from CalPERS, Medco Health ...
Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2] Express Scripts had 2016 revenues of $100.752 billion. [2]
The Pharmacy Competition and Consumer Choice Act of 2011 ( H.R. 1971) is the legislation that was introduced in the 112th United States Congress on May 24, 2011, with the full title of the bill stating to "amend the Public Health Service Act to ensure transparency and proper operation of pharmacy benefit managers". [1]