Benefit management, pharmacy companies providing

Many third parties hire pharmacy benefit managers (PBMs) to provide prescription claims processing and other services. Examples of third parties that hire PBMs are insurance companies, employers, Medicare prescription drug plans, and state Medicaid programs. PBMs establish pharmacy networks as part of their claims management services, so many pharmacy third-party contracts are with PBMs. Examples of other ser-... 

The receipt of a prescription can be subject to several market barriers. First, the pharmacy must have the electronic capability to receive the data. Second, the pharmacy must accept the patient s prescription drug plan and be willing to operate under the financial constraints imposed by the electronic prescribing provider. Finally, the potential exists for pharmacy benefit managers (PBMs) to use electronic prescribing technology to route prescriptions to preferred pharmacies such as mail order companies. 

The term carve-out indicates that administration and management are handled by a specialized PBM company, traditional insurer, or TPA. Carved-out pharmacy benefits provide flexibility, control, and an array of management options to help contain costs and improve quality. 

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