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What Is a Pharmacy Benefit Manager?

Pills from a pharmacy.
Article Details
  • Written By: Misty Amber Brighton
  • Edited By: Allegra J. Lingo
  • Last Modified Date: 13 July 2014
  • Copyright Protected:
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A pharmacy benefit manager is a person who oversees prescription drug benefits for a pool of people. This can be employees of large organizations, or groups of individuals who join together to purchase insurance. The manager normally contracts with drug manufacturers to obtain a discount for the folks he represents. He could also administer mail-order prescription services and maintain formularies, which are formal lists of the particular drugs covered by an insurance plan.

Many medical insurance plans offer a provision, which pays a portion of prescription medications. A pharmacy benefit manager is often responsible for making contacts with drug manufacturers or retail pharmacies in order to obtain a discount on certain drugs. This helps keep the cost of the insurance premium low while continuing to provide coverage for those who need to take medicine.

The employees of some companies may be allowed to order medicine through the mail. A pharmacy benefit manager is normally in charge of overseeing this program. He might contract with mail-order pharmacies to see if they can provide services to a particular group. This is another way of keeping down the cost of insurance, as mail-order pharmacies are often more cost effective to use than retail outlets.

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Insurance companies often determine whether they will pay for a particular medication based upon approved formularies. These are lists of drugs that are approved by a particular provider. A pharmacy benefit manager will often suggest changes to these documents whenever new medicines are approved for public use. He might also recommend certain drugs be removed from the list if they become too costly or are deemed unsafe.

In order to become a pharmacy benefit manager, a person should take college courses in pharmacy benefit management or pharmacology. After this, it might be necessary to pass a licensing exam. Continuing education courses may be required from time to time.

People who have experience working as a pharmacist, pharmacy technician, or pharmaceutical salesperson might do well in one of these positions. A background in medical insurance procedures can also be helpful. Candidates should also possess good organizational and math skills in order to succeed in this line of work.

The need for pharmacy benefit managers is likely to increase as insurance companies work harder to keep down the cost of their plans. People who enjoy negotiating contracts and keeping up to date on advances in the medical field may enjoy a career in this field. Working in this capacity can provide insurance companies, major employers, and private citizens with a valuable service that helps them save money while maintaining their overall health.

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