Pharmacy benefit management companies (PBMs). Why should we be interested?

Over the past decade, pharmaceutical benefit management companies (PBMs) have assumed an expanded role as intermediaries in the design and administration of pharmacy programmes. PBMs now provide a range of sophisticated, clinically oriented services that increasingly influence physicians' prescribing patterns and patients' access to pharmaceuticals. This paper reviews the nature and extent of this new level of intervention that has a tendency to centralise the prescribing and dispensing functions. The terms of engagement between PBMs and pharmaceutical firms that own or do business with PBMs have provoked inquiries and oversight by a number of federal government agencies, including the Food and Drug Administration (FDA). In January 1998, the FDA published a proposed guideline with implications for PBM promotional activities and the drug companies that influence those promotions. The paper concludes with an overview of potential liability issues relevant to the new functions and relationships of PBMs.