Who Really Controls the Costs of Your Pharmacy Benefit Program? Who Should Control It?


This presentation will provide attendees with an overview of the roles and financial impact of the various entities involved in creating the final cost for a drug coverage program. The tools and techniques used by PBM’s to control what medications are to be covered as well as what the client will pay for them will be presented. The roles played by other participants in escalating drug costs such as prescribers, aggregators, discounters and compounding pharmacies will be discussed. Attendees will be provided with recommendations for actions to help mitigate the impact of these activities on their employer’s total benefit costs as well as the health of their co-workers.

Core Competency #1: PRMS - Public Risk Management Skills

Claims Management

Core Competency #2 PA/GBS – Public Administration/General Business Skills:


Core Competency #3: CTIS – Critical Thinking & Interpersonal Skills:

Strategic Planning/ Management

Course Level


Learning Objectives

Objective 1: 1. A description of the various participants in the prescription medication process.
Objective 2: 2. An overview of common strategies used by PBMs and others to increase the costs of a prescription benefit program.
Objective 3 3. An understanding of the impact on cost from the roles played by each participant in the prescription medication process. Recommendations for actions to reduce the cost and improve the efficiency of a prescription benefit program.


Workers’ Compensation