CompletedVideo · 14 min
The PBM’s Role in the Channel
Where the PBM sits between the plan sponsor and the pharmacy — and why that seat is worth more than the claim.
A PBM is not a pharmacy. It is the administrator that designs the formulary, prices the claim to the plan, and pays the pharmacy a different number. The gap between those two numbers is the business.
Manufacturer teams meet the PBM as a rebate counterparty. Plan sponsors meet it as a fiduciary. Pharmacies meet it as a payer. The same company is all three, and the reports treat that as the starting fact, not a footnote.
Key takeaways
- One company, three ledgers
- Formulary design is a pricing tool
- The claim is not the P&L