Typically, PBA services are provided by leading PBMs. PBAs handle administrative services for the client, such as claims processing and data reporting, while other tasks, such as formulary management, rebating, contracting with network pharmacies, and MAC list management, may be managed by the client. PBAĪlthough the concept of a pharmacy benefits administrator (PBA) has been on the healthcare radar for years, it has not yet hit the big time. PBMs, however, are not without detractors who claim PBMs lack transparency in announcing their spread between what clients pay and what managers negotiate with pharmacies, along with maximum allowable costs (MAC) lists that fluctuate at will. Pharmacy benefits managers (PBMs) have had success in reducing drug costs for their clients-health plans and self-insured employers-overseeing the entire drug benefit, negotiating manufacturer discounts and creating pharmacy networks. Related: Four ways clinical pharmacists can improve managed care As the healthcare industry reinvents itself, it continually develops a variety of patient-centric, value-based, delivery and payment models-some with staying power and others tested and forgotten.
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