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Pharmacy Benefit Manager (PBM) & Drug Card Programs

Comprehensive health plans include pharmacy benefits to cover prescription drugs. It's a vital part of every benefit package because prescription drug costs make up a large portion of the claim costs of a health plan. PBA offers prescription plans through preferred Pharmacy Benefit Management (PBM) partners. Our partners offer innovative programs such as specialty drug carveout, international sourcing, copay/patient assistance programs with true member out-of-pocket reporting, and alternate funding sources.

What Is Pharmacy Benefit Manager?

PBM is an industry comprising a group of companies that serve as middlemen between pharmacies, drug manufacturers, and health insurance companies. They are responsible for securing lower costs for prescription drugs for insurance companies and those they insure.

The PBA Solution

Pharmacy benefits can cost health plans and employers more than 20% of their total medical spend. It's never been more important to closely manage your pharmacy program, which is a critical component of PBA's pharmacy benefit best practices. We engage an independent PBM consultant who provides feedback on PBM contracts, allowing our clients to discuss their contract language and terms with the PBM and achieve better prescription cost containment goals. To this end, our independent PBM consultant:

  • Monitors PBM performance to ensure continued satisfaction;
  • Conducts annual claims reviews to ensure PBM contracts adhere to the contracted Average Wholesale Price (AWP) discounts, dispensing fees, and rebate guarantees;
  • Ensures each client is matched with the most cost-effective PBM for their unique needs;
  • Renegotiates PBM contract terms and pricing as opportunities arise; and,
  • Ensures clients have established the right management techniques by providing insight into PBM programs and trends.

We help you put the brakes on runaway prescription drug costs.