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First in a two-part series on the complexities of pharmacy benefit management.
Over the past few decades, pharmacy benefit managers have become integral service providers connecting pharmaceutical companies, pharmacies and employee health insurance plans. PBMs play a pivotal role in administering and managing prescription drug programs for many health insurance plans.
Barbara Tomlin is the Barbara director of the ROSE Program and U.S. Group Re Rose/Rosebud.
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As costs to treat serious conditions surge, employers must plan how to absorb budget-altering expenses ahead of time.
Gap coverage, supplemental benefits and options for various types of workers can help avoid cost shifting and still provide support.
The legislation calls on Congress to lower prescription drug costs, shift subsidies directly to consumers, and enforce strict price transparency.
Employers are under pressure to keep benefits competitive while controlling costs, driving new scrutiny of PBMs, hospital prices and GLP-1 coverage for 2027.
Organizers should ask, "Where are patients getting stuck, where are teams overloaded, and where is the current process failing to scale?"
