Magazine article Drug Topics

Impact of PBMs on Rx Choices Is on the Rise

Magazine article Drug Topics

Impact of PBMs on Rx Choices Is on the Rise

Article excerpt

There's little doubt that pharmacy benefit managers have benefited from the rising price of prescription products: Employers and insurers need help managing the cost of pharmacy benefits and look to the industry for help. PBMs have returned the favor by fueling the growth of Rx volumes.

New data from SMG Marketing Group, a health-care market research and consulting firm, suggest that PBMs are also gaining greater influence over which products are dispensed. While some PBMs are owned by managed care organizations (MCOs) and manufacturers, and others contract with them, PBMs are generally seen as a middleman with strong influence on physician prescribing patterns. SMG data show that more than 79% of health maintenance organizations allow physicians to override formulary decisions, but many exert pressure on prescribing patterns through PBMs' use of utilization review letters and risk pools.

Roughly 89% of HMO Rxs are filled using some type of formulary, according to SMG; only 10. …

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