ArticlePharmacoEconomics2017
Pharmacy Benefit Management Companies: Do They Create Value in the US Healthcare System?
Article in PharmacoEconomics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
10 citing papers in PubMed.
- What should infectious diseases clinicians know about pharmacy benefit managers and their impact on our patients?Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- International price comparisons for national price-negotiated drugs in China: a cross-regional analysis.Health policy and planning · 2025Article
- Drug costs in context: assessing drug costs in cost-of-illness analyses.Drugs in context · 2022Article
- Value-based pricing: Toward achieving a balance between individual and population gains in health benefits.Cancer medicine · 2020Article
- Measurement of the Equality of the Drug Welfare Induction Level of Chinese Patients With Chronic Diseases in Gansu, Sichuan, Hebei, and Zhejiang Based on the Bivariate Theil-T Index Method.Frontiers in public health · 2020Article
- An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices.Pharmacy (Basel, Switzerland) · 2019Article
- Estimating Drug Costs: How do Manufacturer Net Prices Compare with Other Common US Price References?PharmacoEconomics · 2018Article
- Economic Impact of Oral Therapies for Chronic Lymphocytic Leukemia-the Burden of Novelty.Current hematologic malignancy reports · 2018Review
- A Transparent and Consistent Approach to Assess US Outpatient Drug Costs for Use in Cost-Effectiveness Analyses.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2018Article
- Is ICER NICEr?PharmacoEconomics · 2018Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing. Whether these potential outcomes are realized within the relevant budget is a function of the healthcare system and the interaction of benefit design and clinical processes-not just individually vetted components. Efficiencies and values achieved in price discounts and cost sharing can be nullified if there is irrational prescribing (over-utilization, under-utilization and mis-utilization), variable patient adherence to medication regimens, ineffective formulary processes, or fraud, waste and abuse. Rising prescription drug costs and the increasing prevalence of 'high deductible health plans', which require much greater patient out-of-pocket costs, is creating a crisis for PBM efforts towards an affordable pharmacy benefit. Since PBM rebate and incentive contracts are opaque to the public, whether they add value by restraining higher drug prices or benefit from them is debatable.
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Registered trials
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