Pharmacy benefit managers (PBMs), such as Express Scripts, CVS Caremark, and Optum Rx, are some of the larger companies that administer the Medicare Part D prescription drug benefit. These companies facilitate access to prescription drugs for beneficiaries, and because each company generally has millions of enrollees, they leverage their size to extract price concessions from pharmaceutical manufacturers. Because Medicare is not permitted to negotiate drug prices directly, the program and beneficiaries rely on PBMs to negotiate on their behalf.
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Dusetzina SB, Bach PB. Prescription Drugs—List Price, Net Price, and the Rebate Caught in the Middle. JAMA. Published online March 06, 2019321(16):1563–1564. doi:10.1001/jama.2019.2445
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