Benefit managers

Pharmacy Benefits Management Strategic Health Care Group... 

Danzon, Patricia M. 2000. Pharmaceutical Benefit Management An Alternative... 

Grabowski, Henry, and C. Daniel Mullins. 1997. Pharmacy Benefit Management Cost-Effectiveness Analysis and Drug Formulary Decisions. Social Science and Medicine 45(4) 535-544. 

Kreling, D. H., T. Collins, H. Lipton, and K.C. Hertz. 1996. Assessing the Impact of Pharmacy Benefit Managers. HCFA Contract Report, HCFA 95-023/PW, September 30. 

URAC. 2007. Pharmacy Benefit Management available at www.urac.org/programs/pbm.aspx accessed on June 26, 2007. 

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 use of prescription medication for ADHD doubled between 2000 and 2004 (Hitti, 2005 Elias, 2005), according to data compiled by Medco Health Solutions, one of the nation s largest prescription benefit managers. The increases were largest among adults age 20-44, especially... 

In 1993 and 1994 Merck, Lilly, and the then SmithKline Beecham all bought PBMs. In addition, Bristol-Myers Squibb had bid against Merck, and Pfizer and Johnson Johnson at one point considered purchasing benefits managers, too. Yet by 1999, Lilly and SmithKline had sold theirs at a loss, and Bristol-Myers, Johnson Johnson and Pfizer never got in. Merck alone seemed to be able to make its PBM, Merck-Medco Managed Care, work. By 2001, its market share was nearly 29 percent by 2002, it handled the prescriptions for 65 million people, or almost one-fourth of all Americans. 

Typical of a managed care or pharmacy benefit management (PBM) formulary. 

Sullivan SD, Lyles A, Luce B, Grigar J. AMCP guidance for submission of clinical and economic evaluation data to support formulary listing in U.S. health plans and pharmacy benefits management organizations.. Manage. Care Pharm. 2001 7 272-282. 

PricewaterhouseCoopers LLP (2001). HCFA Study of the Pharmaceutical Benefit Management Industry. Washington, D.C. Centers for Medicare and Medicaid. Available at www.cms.hhs.gov/researchers/reports/2001/CMS.pdf. 

Sroka, C. (2000). CRS Report for Congress Pharmacy Benefit Managers. Washington, D.C. Library of Congress Congressional Research Service. 

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