Module #3 – Formularies and Pharmacy Benefit Managers

The objective of a PBM is to provide plan members with access to medications while keeping costs to a minimum. Their role includes all of the following except one. Which one?

PBMs allow for which of the following? (check all that apply)

If a drug plan formulary is a list of drugs that is covered under a health plan, what is true about formularies? (check all that apply)

True and false: Before electronic claims submissions through PBMs, reimbursement was problematic for insurers, plan sponsors and plan members because:

1. Insurers made coverage decisions after claims were incurred
2. Plan sponsors received employee complaints about coverage decisions and sometimes felt obligated to pay claims outside the contract
3. Plan members did not know if their claim would be reimbursed when their expense was incurred

What are opportunities (actual or potential new services) for PBMs?