Pharmacy Benefit Managers' Role in Facilitating Medicare Beneficiary Access to Pharmaceutical Care
This paper assesses the role that pharmacy benefit managers (PBMs) could play in facilitating improved Medicare beneficiary access to pharmaceutical care (which includes access to pharmaceuticals as well as disease management coverage). Based on a literature review and original survey results, PBMs currently facilitate access to pharmaceuticals for an estimated 26% of Medicare beneficiaries. In the short term, with implementation of the Bush Administration's prescription drug discount plan, or in the longer term, with the passage of Medicare prescription drug benefit legislation, PBMs could increase their presence in the Medicare market considerably. Nevertheless, a number of issues concerning how to structure contracts with PBMs and how to meet certain political challenges to PBM-mediation remain unresolved. All PBMs surveyed have developed and are expanding disease management programs that include Medicare beneficiaries. However, disease management budgets remain modest. Furthermore, three-quarters of the PBMs surveyed adopted a focused view of disease management that may limit their ability to optimally facilitate cost-effective access to pharmaceutical care for Medicare beneficiaries.
Health services accessibility, Pharmacoeconomics, Reimbursement
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