Madelaine A. Feldman, MD, FACR
Private Practice, The Rheumatology Group
Clinical Assistant Professor of Medicine
Tulane University School of Medicine
New Orleans, LA

Pharmaceutical benefit managers (PBMs) are playing an increasingly important role in establishing access to pharmaceutical products for patients. PBMs set retail prices for pharmaceutical products, negotiate "rebates" from manufacturers based on total sales volume of products, and achieve several types of postsale price concessions and payments from pharmacies. All of these activities describe a complex flow of funds that has not been transparent to clinicians or to patients.

In this informative presentation, Dr. Feldman provides awareness about the industry of Pharmacy Benefit Managers (PBMs), including formulary construction and utilization management tools, how PBMs impact actual cost to employers and/or patients, legislation which might impact PBMs and drug prices for patients, and insight about the withdrawn rebate rule.

At the conclusion of the session, learners should be better informed about the role that PBMs play in the process of negotiating payment rates for a large share of prescription drugs distributed in the U.S.