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.

Rising drug price inflation

636 medications had their prices increased by pharmaceutical manufacturers in the first week of January 2022
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Most top 25 Medicare Part D drugs had price increases above inflation in 2020

Most top 25 Medicare Part D drugs had price increases above inflation in 2020.
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Without PBMs, drug costs would go up…

$1,040 per person

annual savings for payers and patients1

Per $1 spent

on their services, PBMs reduce health care costs by $102

$1 trillion

anticipated savings for plan sponsors and consumers from 2023-2032; saving Medicare Part D and Managed Medicaid plans and beneficiaries $437B and more than $100B, respectively3

1 billion

anticipated medication errors that PBMs will prevent over the next 10 years4

behind-the-scenes

PBMs work to deliver value for clients and consumers— partnering seamlessly at every step of the drug supply chain

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How PBMs create value across the drug supply chain to provide lower premiums, expand medication access, fund wellness plans, and reduce medication cost at point-of-sale for members.

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.

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PBMs save private sector employers patients $625 per year on prescription drug costs: up to $75 on generics, $406 on brands, and $144 on specialty drugs.

Sources

  1. 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.
  2. 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.
  3. Pharmacy Benefit Managers (PBMs): Generating Savings for Plan Sponsors and Consumers. Prepared for PCMA. January 2023.
  4. 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.