--- title: "Pharmacy Benefit Managers (PBMs): Policy, Reform, and Patient Access" description: Learn how pharmacy benefit managers influence prescription drug coverage, what recent PBM reforms change, and how these policies affect patient access and affordability. image: https://www.patientsrising.org/hubfs/Untitled%20(1240%20x%20620%20px).png --- [![Patients Rising](https://www.patientsrising.org/hs-fs/hubfs/raw_assets/public/PatientsRising-u4m/templates/images/patients_rising_logo.png?width=120&height=900&name=patients_rising_logo.png "Patients Rising")](https://www.patientsrising.org/) - Policy Center - - [Policy Framework ](https://www.patientsrising.org/policy) - [Affordability ](https://www.patientsrising.org/policy/affordability) - [Accountability ](https://www.patientsrising.org/policy/accountability) - [Innovation ](https://www.patientsrising.org/policy/innovation) - [Federal Healthcare Policy ](https://www.patientsrising.org/policy/federal) - [Learning Center ](https://www.patientlearningcenter.org/) - - [LEAD Education ](https://www.patientlearningcenter.org/lead) - [Our Community ](https://www.patientsrising.org/our-community) - [Patient Senate ](https://www.patientsrising.org/patient-senate) - Insights - - [All Posts ](https://www.patientsrising.org/advocacy-updates) - [PR Magazine ](https://www.patientsrising.org/pr-magazine) - [Patient Stories ](https://www.patientsrising.org/advocacy-updates/tag/patient-stories) - [Medical Bankruptcy in America ](https://www.patientsrising.org/medical-bankruptcy-america) - [State of the Patient Podcast ](https://www.patientsrising.org/state-of-the-patient-podcast) - Get Involved - - [Share Your Story ](https://www.patientsrising.org/storyshare) - [Become an Advocate ](https://www.patientsrising.org/become-an-advocate) - [Join the Patient Senate ](https://www.patientsrising.org/patient-senate) - [Join Our Community ](https://www.patientsrising.org/community) - [Events ](https://www.patientsrising.org/events) - - [State of the Patient Summit & Rise Awards ](https://www.patientsrising.org/events/summit-and-rise-awards) - [Advocacy Fly-ins ](https://www.patientsrising.org/patients-rising-fly-in) - [Virtual Lunch n' Learns ](https://www.patientsrising.org/events) - Virtual Town Halls - About Us - - [Our Mission ](https://www.patientsrising.org/about-patients-rising) - [Our Principles ](https://www.patientsrising.org/patients-rising-principles) - [Our Team ](https://www.patientsrising.org/team) - [Our Board of Directors ](https://www.patientsrising.org/board) - [Our Advisory Councils ](https://www.patientsrising.org/advisory-council) - [Partners and Coalitions ](https://www.patientsrising.org/partners) - Corporate Partnerships - [Funding & Financial Reports ](https://www.patientsrising.org/financial-transparency) [Donate ](https://patientsrising.org/?form=support-patientsrising) This is a search field with an auto-suggest feature attached. - There are no suggestions because the search field is empty. HEALTH POLICY EXPLAINER # How Pharmacy Benefit Managers Shape Prescription Coverage Pharmacy Benefit Managers administer prescription drug benefits on behalf of insurers, employers, and public programs. Their decisions influence which medications are covered, what patients pay, and how prescriptions are dispensed.  **Patients Rising believes lasting healthcare reform requires collaboration across the entire system. Our role is to bring forward the patient perspective and help ensure policies improve access, affordability, and outcomes for the people the healthcare system exists to serve.** Learn How PBMs Affect Patients ![pharmacy counter patient and pharmacist](https://www.patientsrising.org/hubfs/pharmacy%20counter.png) ## What PBMs Do Pharmacy Benefit Managers administer prescription drug benefits on behalf of health insurers, employers, and government programs. They negotiate prices with manufacturers, design formularies, and coordinate pharmacy networks. ## Why PBMs Matter Because PBMs help manage prescription coverage for more than 200 million Americans, their policies directly influence how patients access medications and what they pay at the pharmacy. ## What’s Changing New federal legislation has introduced reforms designed to increase transparency and curb controversial PBM practices, particularly in Medicare and Medicaid programs. Button DRUG SUPPLY CHAIN ## Where PBMs Fit in the Prescription Drug System Prescription medicines move through a complex system involving manufacturers, insurers, pharmacies, and benefit administrators. Pharmacy Benefit Managers help coordinate many of the processes that connect these parts of the healthcare system. PBMs negotiate drug prices with manufacturers on behalf of health plans and employers, develop formularies that determine which medications are covered, and administer pharmacy networks that dispense prescriptions to patients. Because PBMs operate between several key parts of the healthcare system, their policies can influence how medicines are priced, how coverage decisions are made, and how patients ultimately access their prescriptions. Button ![Drug_Channel_System-Jan2016](https://www.patientsrising.org/hubfs/Drug_Channel_System-Jan2016.png "Drug_Channel_System-Jan2016") [![Patients Rising](https://www.patientsrising.org/hubfs/raw_assets/public/PatientsRising-u4m/templates/images/footer-logo.svg "Patients Rising")](https://patientsrising.org) Empowering every patient in America to advocate for reforms placing them, alongside their doctors, in control of their healthcare choices. 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