ABSTRACT
Pharmacy benefit managers (PBMs) are companies that administer prescription drug benefits on behalf of health plan sponsors. In contrast to traditional pharmaceutical benefit plans, which are administered through the overall health plan, PBMs "carve out" pharmaceuticals from the major medical benefit. From an administrative standpoint, the most notable distinction between PBMs and traditional pharmaceutical coverage is the on-line point-of-service adjudication system that PBMs offer. Using this on-line system, pharmacists can verify patient eligibility and plan design prior to dispensing prescriptions.
