Plan Sponsors Should Beware Hidden Costs From PBMs

Law360 (April 10, 2019, 3:51 PM EDT) -- Today, four pharmacy benefit managers, or PBMs, in the United States manage 95% of the drug benefits and hundreds of million American lives. These PBMs (CVS Health Inc.[1], Express Scripts Inc., OptumRx Inc.[2], and Prime Therapeutics) have been lobbying Washington to protect their interests, which do not align with plan sponsors' interests.

Beyond their traditional claims processing, PBMs are now involved in drug utilization review, drug plan formulary development, determining which pharmacies are included in the prescription drug plan's network, deciding how much network pharmacies will be reimbursed for their services, and operating mail order and specialty pharmacies themselves. PBMs have...

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