Becker’s Hospital Review: Health System Pharmacists Want to Manage Specialty Pharmacy Care For Their Complex Patients. The PBMs Are Making It Difficult.

By Prashant Dilwali The majority of the population get their insurance through employers. Employers choose a health insurance plan which covers all the expenses associated with a patient’s medical care: visits to the hospital, physician office or urgent care center, etc.  However, if the patient is prescribed any medication, the health insurance plan segments out the pharmaceutical / medication therapy care to a pharmacy benefits manager, or PBM (see Figure 1). The PBM then identifies where the patient can receive this portion of their therapy – specifically identifying which pharmacy is considered “in network” for the patient  (See the full article in Becker’s Hospital Review)