Pharmacy Benefit Managers (PBMs) play a crucial role in the prescription drug supply chain, acting as intermediaries between drug manufacturers, pharmacies, and insurance companies. They help manage prescription drug benefits, negotiate prices, and determine which drugs are included in health plan formularies. But how do they come up with the prices for medications, and what are contracted rates?
Imagine this: Jane, a dedicated teacher, was recently diagnosed with rheumatoid arthritis. The diagnosis itself was overwhelming, but what followed was equally challenging—managing her prescription coverage and understanding step therapy.
The Beginning of the Journey
Jane’s doctor prescribed a medication that could potentially ease her pain and improve her quality of life. Eager to start her treatment, she headed to the pharmacy, only to learn that her insurance required something called “step therapy.”
Unpacking Step Therapy
Step therapy is essentially a process used by insurance companies to control the cost and ensure…
Navigating the world of prescription coverage insurance can feel like learning a new language. But fear not—once you understand the key terminologies, it all starts to make sense. Here’s a guide to help you decode the jargon and make informed decisions about your healthcare.