Literature Review Examines PBM Functions and Value Across Payer Types, Including Managed Medicaid

Avalere's white paper synthesizes published evidence on PBM roles across the healthcare system, including their administration of prescription benefits for managed Medicaid plans alongside commercial, employer, and Medicare Part D populations. The review examines PBM impact on costs, access, and clinical outcomes, finding evidence of adherence improvements and cost savings through rebate negotiations, while acknowledging heightened regulatory scrutiny from federal and state policymakers. For Medicaid MCO pharmacy directors and compliance teams, the paper provides context on PBM value propositions and evolving oversight landscape relevant to their vendor relationships and state contract requirements.

Pharmacy · Managed Care

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

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