Pharmacy Benefit Management is an Integral Part of the Medicare System

 


Pharmaceutical drug prices are rising and contribute significantly to total health expenditure worldwide. Since 2014, prescription drug prices have increased by 33%. In 2020, global spending on prescription drugs is expected to be US$ 1.3 trillion. Increasing drug prices and consumer spending on prescription drugs are increasing the demand for the pharmacy benefit management system. The system is operated by third-party administrators who act as a link between drug manufacturers, insurance providers, and pharmacists. The system assists in reducing drug prices by negotiating with drug manufacturers and retail pharmacies.

Those who are enrolled in various health schemes and those without insurance can get the benefit of the pharmacy benefit management system. The system provides medicines at a lower price than those available at retail pharmacies. To reduce rising health expenses, Japan planned to start reviewing drug prices every year instead of every two years. The move reflects growing resistance to rising drug prices worldwide. In Europe, different approaches have been implemented to regulate drug prices. In Germany, manufacturers can freely set the prices of newly developed drugs during their first year on the market. Benefit assessments are done during this year and then used in price negotiations between manufacturers and the country's representatives of statutory health insurers.

Moreover, Mexico has also implemented several approaches to regulate the pharmaceutical sector. The government has implemented an information platform, price negotiations, and pooled procurement to improve the affordability and availability of medicines in the country. All health-care providers must understand and comply with the rules and regulations of the Health Insurance Portability and Accountability Act, including those related to the process of offering pharmacy benefit programs. Pharmacy benefit management programs are designed to provide convenient, safe, effective, seamless benefits for patients.

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