PBM Basics
The foundational knowledge you need to understand pharmacy benefit managers and their role in healthcare.
What Is a PBM?
The intermediary between insurers, pharmacies, and drug makers. What they do, and why they exist.
How PBMs Make Money
Spread pricing, rebate retention, admin fees, mail-order margins, and specialty pharmacy revenue.
The Big Three PBMs
CVS Caremark, Express Scripts, and OptumRx control roughly 80% of the market. Their parent companies and structures.
PBM Rebates Explained
How manufacturer rebates flow through PBMs and why the rebate system creates perverse incentives.
PBM vs. PBO
Pharmacy benefit optimizer models that claim to eliminate conflicts of interest. What changes and what stays the same.
Vertical Integration
When your PBM owns the pharmacy, the insurer, and the clinic. The consolidation reshaping pharmacy benefits.