Pharmacy Benefits Managers, or PBMs, are for-profit companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers.

PBMs are powerful middlemen at the center of the U.S. prescription drug system. PBMs negotiate rebates and fees with drug manufacturers, create drug formularies and policies for health care plans, and reimburse pharmacies for patients’ prescriptions. The largest PBMs control around 80 percent of the market for prescription drug access and have enormous influence over which medicines are prescribed to patients, which pharmacies patients can access, how much patients will pay at the pharmacy counter and the amount pharmacies are ultimately reimbursed. Yet, PBMs are one of the least regulated sectors of the health care system.

Guiding Principles

Patient choice of pharmacy

Patient access to lowest out of pocket cost medication

Fair & transparent reimbursement to pharmacies in both commercial and government plans

Full transparency for employers/plan sponsors

Who We Are

Our coalition includes patient advocacy organizations, prescriber organizations, pharmacy organizations (including chain, independent community, grocery, specialty, and other retail pharmacies) employer-sponsored health groups, business organizations, and other stakeholders.

Downloadable Onesheet on the Coalition for PBM Reform