A PBM (pharmacy benefits manager) is a company that processes and pays for claims while assisting the employer with managing prescription benefits (Du, Jack). There are “three big PBMs that cover most of the roughly 4 billion retail prescriptions that were filled in the US in 2015: Express Scripts, CVS Caremark, and OptumRx” (Ramsey). Their job is to negotiate contracts with pharmaceutical manufacturers or pharmacies. They are supposed to favor the most effective drug for their consumer. The American Journal of Pharmacy Benefits states, “They [PBMs] have been successful in reducing medication cost by negotiating lower drug prices from pharmacies and rebates and other discounts from manufacturers, and they have been likewise successful in improving utilization of medicines by working with prescribers on drug selection and helping patients adhere to prescribed medication regimens to better manage their disease(s)” (Is PBM…). The clients are responsible for arranging PBM services. These negotiators are able to provide their clients with electronically, automated claims. The journal continues to explain how the claim process works as it states, “The claims …show more content…
Without a clear knowledge of rebates, consumers’ understandings are very limited. They are unable to know why the price of their prescription drugs continues to rise. All they see is the final counter cost, which they are expected to pay. In Business Insider, Ramsey states, “Those numbers …don't account for rebates and other discounts that are factored in, and in the case of the price we see at the pharmacy counter, we don't know how big a cut each part of the supply chain gets” (Ramsey, Lyndia. “A…). Since only the final cost is shown, consumers are unaware of what they are all paying exactly for. They aren’t able to see the rebates or the fees that have been added on to the cost. Therefore, the price of prescription drugs is able to continuously