University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Carey Business School, 624 N Broadway, Baltimore, MD, 21205, USA.
Res Social Adm Pharm. 2022 Nov;18(11):3995-4002. doi: 10.1016/j.sapharm.2022.07.045. Epub 2022 Jul 31.
Pharmacy Benefit Managers (PBMs) originated in the 1960s to address a market need providing services to insurance companies in managing the newly introduced prescription drug benefits. Since then, PBMs have been expanding their roles in the prescription drug supply chain and have come under scrutiny. As of November 2021, all 50 states have enacted some form of regulation on PBMs. These state-level regulations focus on a variety of different policy levers, many of which align with advocacy efforts led by community pharmacists that focus on business transactions between pharmacies and PBMs without evidence supporting how these policies would enhance the patient experience, improve population health, lower costs, or improve the experience of health care providers. Many state policies could help increase transparency, prevent anticompetitive behavior between PBM-owned and independently-owned pharmacies, and increased accountability of PBMs to plan sponsors. However, there were no direct mechanisms to ensure that the potential benefits of these policies would ultimately be realized as savings for the health care system or consumers, improved health outcomes, or increased quality of care.
医药福利管理机构（PBMs）起源于 20 世纪 60 年代，旨在满足保险公司在管理新引入的处方药福利方面的市场需求。自那时以来，PBM 在处方药供应链中的作用不断扩大，并受到了审查。截至 2021 年 11 月，所有 50 个州都对 PBM 实施了某种形式的监管。这些州级法规侧重于各种不同的政策杠杆，其中许多与社区药剂师领导的倡导努力相一致，这些努力侧重于药房和 PBM 之间的商业交易，而没有证据表明这些政策如何增强患者体验、改善人口健康、降低成本或改善医疗保健提供者的体验。许多州政策可以帮助提高透明度，防止 PBM 所有和独立拥有的药房之间的反竞争行为，并增加 PBM 对计划赞助商的问责制。然而，没有直接的机制来确保这些政策的潜在好处最终会以节省医疗保健系统或消费者的成本、改善健康结果或提高护理质量的形式实现。
