Why does the exact same medication cost $10 for one patient and $500 for another? Who decides which drugs are covered and which pharmacies patients can use? The answer often lies with Pharmacy Benefit Managers (PBMs). In this 90-minute session, we’ll demystify the PBM industry, explore how these organizations influence medication access and costs, and discuss the controversies and policy changes reshaping the prescription drug landscape. Patient advocates will leave with a better understanding of the system and practical knowledge to support clients facing pharmacy benefit challenges. This session has been approved for 1.5 General CEs by the Patient Advocate Certification Board.
LEARNING OBJECTIVES
By the end of this session, participants will be able to:
- Break down the pivotal role Pharmacy Benefit Managers (PBMs) play within the healthcare supply chain.
- Analyze how PBM decisions regarding formularies, clinical programs, and pharmacy networks directly shape provider choices and patient out-of-pocket costs.
- Evaluate the latest legislative shifts and industry controversies currently reshaping the PBM landscape.