PBMs are one of the primary tools employers use to manage rising prescription drug costs while maintaining broad access to treatments for employees and their families.
PBMs play a central role in administering prescription drug benefits for employer-sponsored health plans. They work on behalf of employers and health plans to negotiate drug prices, manage pharmacy networks, and help ensure patients have access to affordable medications.
PBMs are one of the primary tools employers use to manage rising prescription drug costs while maintaining broad access to treatments for employees and their families.
PBMs help employers navigate a complex pharmaceutical marketplace by:
These functions allow employers to offer prescription drug coverage that balances cost, access, and quality.
PBMs use a range of tools to reduce costs across the system:
Negotiated Pricing: PBMs leverage scale to negotiate lower prices from drug manufacturers.
Pharmacy Network Management: PBMs contract with pharmacies to create networks that offer competitive pricing and accessible care.
Formulary Management: PBMs develop lists of covered drugs that prioritize effective, lower-cost alternatives when appropriate.
Mail-Order and Specialty Pharmacy Access: PBMs support delivery models that can improve adherence and reduce costs for maintenance and specialty medications.
Recent legislative proposals at both the state and federal levels seek to regulate PBMs and the broader pharmacy system. While intended to address concerns within the healthcare system, some proposals may have unintended consequences for employers and patients.
MEBA is closely monitoring policies that may:
Changes to how PBMs operate can directly affect the cost of prescription drug coverage. When cost-management tools are limited or removed, those increases are often passed on to employers and employees through higher premiums, out-of-pocket costs, or reduced benefit flexibility.
Maintaining a balanced approach to policy—one that preserves cost-saving tools while ensuring access to care—is critical to keeping prescription drug coverage affordable and sustainable.
Our focus is on how proposed policies affect employers, working families, and the broader healthcare system.
There are at least 177 million Americans with employer-based health coverage, compared with 120 million with other coverage and 28 million uninsured.
PBMs are one of the primary tools employers use to manage rising prescription drug costs while maintaining broad access to treatments for employees and their families.
ERISA is a federal framework for stability in employer health plans. The protections plays a central role in ensuring that healthcare remains accessible and sustainable for millions of working families.
