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Leading Prescription Benefit Managers

May 30, 2007
Related Topics: Benefit Design and Communication, Health and Wellness, Featured Article, Compensation

Pharmacy Benefit Managers: State of the Industry

More than 200 million people—about 71 percent of the U.S. population—are part of private plans with pharmacy benefit managers, according to a March 2007 report by PricewaterhouseCoopers prepared for the Pharmaceutical Care Management Association. In 2008, approximately 76 percent of drug spending for the non-Medicare population will be in private plans where pharmacy benefits are managed, and estimated total savings in drug costs from pharmacy benefit management will be $8.5 billion, according to PricewaterhouseCoopers.

Although PBMs have shown that they can save their clients money, how much of the savings they should keep and how much they should pass on to clients was the subject of numerous lawsuits in recent years. In 2006, 22 states considered proposals calling for additional PBM regulation, including fiduciary or disclosure requirements. None of those measures passed. Some large employers, meanwhile, have decided that PBMs do not deliver the kind of savings they could reap if they aggressively managed their own pharmaceutical spending, and are beginning to do so.
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