PBM 101, Part 1: Why PBMs Matter for Employers

ProCare Rx Team • September 5, 2025

PBM 101, Part 1: Why PBMs Matter for Employers

Pharmacy costs continue to climb, putting pressure on employers and plan sponsors to do more with less. A recent survey found that 51% of large U.S. employers plan to shift more healthcare costs to workers in 2026, with prescription drugs - especially GLP-1 and specialty medications - being the main driver.


Amid these challenges, many are asking: what role does a pharmacy benefit manager (PBM) actually play?


Let’s start by looking at what a PBM is.


A pharmacy benefit manager is not an insurance company. Instead, PBMs administer the prescription drug portion of health benefits by:

  • Processing and paying prescription claims
  • Negotiating prices with pharmacies
  • Developing formularies - the list of drugs covered by the plan
  • Offering rebate programs to help offset costs


In short, a PBM ensures that members can access needed medications while helping employers control spend.


Why It Matters

PBMs do more than process transactions. The right partner can:

  • Encourage generics and lower-cost options when appropriate
  • Build pharmacy networks that lower costs while improving access
  • Monitor prescription safety and reduce medication errors
  • Provide technology tools for easier refills, adherence, and reporting


For plan sponsors, understanding what a PBM does is the first step. In today’s environment of rising costs and new therapies, it is also the first step toward selecting the right partner.


Next in this two-part PBM 101 series: how rising drug costs are reshaping the role of PBMs, and what to look for in a PBM partner.


Sources-
https://www.reuters.com/legal/litigation/many-us-employers-plan-pare-health-benefits-weight-loss-spending-soars-2025-07-16/ 



About ProCare Rx
ProCare Rx is a privately held, independent pharmacy benefit manager (PBM) that has empowered healthcare and self-insured organizations since 1988. We provide fully integrated, in-house solutions—including claims adjudication, clinical program design, pharmacy network access, cost containment, and data analytics—all supported in the U.S. Our flexible, transparent model serves self-insured employers, third-party administrators (TPA), brokers, health plans, health systems, managed care organizations (MCO), unions, workers’ compensation programs, Medicare, Medicaid, hospices, and other PBMs. With a proprietary technology platform, commitment to ethical operations, and a focus on lowest net cost, ProCare Rx delivers long-term value, clinical performance, and trusted pharmacy benefit partnerships.

Media Contact:
Marc Cohen, VP, Marketing and Sales
marketing@ProCareRx.com

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