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.