What is Pharmacy Benefit Management?
A pharmacy benefit manager (PBM) acts as a third party between the pharmacy and the patient. The pharmacy benefit manager is a company that handles the distribution and payment for medication. PBMs negotiate with insurance companies to receive the best rates for prescriptions.
How can PBMs help?
Here are some of the functions of the PBMs:
- Handle the mailing of prescription medications
- Help educate patients about prescription drugs and ensure compliance
- Distribute prescription drugs to different pharmacies
- Negotiate rebates with insurance companies
- Connect pharmacies to prescription drug suppliers
PBMs play a crucial role in the relationship between patients and pharmacists. PBMs also handle all prescription drugs, including those used for fertility treatments such as in vitro fertilization (IVF). There are two types of pharmacy benefit managers, ones that work for pharmacies and others that work independently.
How can PBMs help me with prescription drugs?
Since PBMs control the price of drugs and the type of drugs offered to patients, PBMs are an important part of the IVF process. Depending on the patient’s insurance plan, fertility drugs may or may not be covered. If drugs aren’t covered, then patients must pay for prescriptions out-of-pocket. Fertility drugs are considered medical drugs and aren’t grouped together with other medications. PBMs work to keep prescription drug costs down and act as the deciding factor in keeping coverage affordable.
Additionally, PBMs work with drug companies and pharmacies to create formularies. A formulary is a list of prescription drugs deemed safe for use by the Federal Drug Administration (FDA). Fertility drugs are constantly being tested and patients need to know if the drugs are safe. PBMs make all this possible.
Talking to a doctor
Any person or couple deciding to undergo in vitro fertilization is making a big, life-altering decision. The procedure takes time, patience, energy, and money. Therefore, people should understand all the implications of IVF, including prescription drug costs. Couples can consult with a pharmacist about how PBMs can help keep IVF costs manageable.