Pharmacy Benefit


Medications prescribed by physicians for common chronic and acute conditions are normally covered by a pharmacy benefit. These drugs are usually purchased through retail or mail order providers, and are typically self-administered. Many insurers work directly with a PBM and have access to information and management strategies for drugs paid under the pharmacy benefit. However, because PBMs specialize in managing only retail and mail drugs covered under the pharmacy benefit, most states, insurers, or large employers do not have programs in place to track and manage the products and services that are covered under the medical benefit and delivered in the patient’s home or the physician’s office. This area is expected to increase most dramatically over the next six to eight years.


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