How a PBM works
Express Scripts, and other PBMs, are essential partners across the drug supply chain—helping drive down drug spend and improve medication access for clients and customers.
Today, high prescription drug costs are often incorrectly blamed on PBMs
But facts are facts: it is not PBMs but others in the supply chain, starting with pharmaceutical manufacturers, who are solely responsible for setting and raising drug prices. In fact, list prices have continued to significantly increase year-over-year.
Without PBMs, drug costs would go up…
behind-the-scenes
PBMs work to deliver value for clients and consumers— partnering seamlessly at every step of the drug supply chain
PBMs like Express Scripts help clients put money back into consumer wallets
PBMs keep other players in the drug supply chain in check.
PBMs lower the cost of generics, branded and specialty drugs to deliver more savings and provide greater access to medications and life-saving therapies for consumers and clients.
Sources
- Visante estimates for 2022 based on data from multiple sources, including CMS National Health Expenditures, Drug Channels and IQVIA. The Return on Investment (ROI) of PBM Services. Visante on behalf of PCMA. January 2023. https://www.pcmanet.org/wp-content/uploads/2023/01/The-Return-on-Investment-ROI-on-PBM-Services-January-2023.pdf
- Visante estimated ROI of 10:1 is based on estimates from Drug Channels, as well as 10-Q Reports. The Return on Investment (ROI) of PBM Services. Visante on behalf of PCMA. January 2023. https://www.pcmanet.org/wp-content/uploads/2023/01/The-Return-on-Investment-ROI-on-PBM-Services-January-2023.pdf
- Pharmacy Benefit Managers (PBMs): Generating Savings for Plan Sponsors and Consumers. Prepared for PCMA. January 2023. https://www.pcmanet.org/wp-content/uploads/2023/01/Pharmacy-Benefit-Managers-PBMs-Generating-Savings-for-Plan-Sponsors-and-Consumers-January-2023.pdf
- Visante estimate based on more than 6 billion (retail and mail pharmacies) Rx per year (IQVIA), and 12% of Rx trigger DUR alert, 21% of alerts result in Rx change (Fulda et al, Current Status of Prospective Drug Utilization Review. J Manag Care Pharm. 2004;10(5):433-41.) The Return on Investment (ROI) of PBM Services. Visante on behalf of PCMA. January 2023. https://www.pcmanet.org/wp-content/uploads/2023/01/The-Return-on-Investment-ROI-on-PBM-Services-January-2023.pdf.