PBM

Definition

A Pharmacy Benefit Manager (PBM) is a third party administrator of prescription drug programs. They are primarily responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining the formulary, contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers.

Current PBM List as of 8/12/14

• Abarca Health
• Aetna
• Argus Health
• Catamaran
  • CatalystRx
  • CatalystRx (WHI- Walgreens Health Initiatives
  • Omde[endent Health
  • Medmetrics
  • MS-21
  • Presbyterian Health
• CVS Caremark
  • Pharmacare
  • RxAmerica
• Envision
• Express Scripts
• Laker SOftware
• Mckesson'Relay Health
• MedImpact
• MedMetrics Health Partner
• MeridianRx
• National Pharmaceutical Services (Division of PTI)
• Navitus
• OptumRX
• Pharmacy Data Management Inc.
• PharmPix
• Prime Therapeutics
• RESTAT
• Syrtis Solutions
• US Script
• Wellpoint

Medicaid (Fee for Service)

• Catamaran
  • TennCare
• HP Enterprise Services
  • Alabama
  • Arkansas
  • Connecticut
  • Delaware
  • Pennsylvania
• Megellan Medicaid Administration
  • Florida
  • Idaho
  • Kentucky
  • Michigan
  • Pennsylvania (PACENC)
• Molina
  • West Virginia
• Syrtis Solutions
  • Minnesota
• Xerox State Healthcare
  • New Mexico
  • Texas