Pharmacy Benefit Manager (PBM) definition

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Pharmacy Benefit Manager (PBM) means the prescription drug program vendor listed on your identification card.

Pharmacy Benefit Manager (PBM) means the entity that administers the prescription drug portion of the Plan. The PBM is expected to provide pharmacy claims processing, mail order pharmacy services, and other services, such as rebate negotiations with drug manufacturers, development and management of pharmacy networks, Formulary management, drug utilization review programs, generic drug substitution, and disease management programs.

Examples of Pharmacy Benefit Manager (PBM) in a sentence

Prescription drugs and diabetic equipment and supplies bought at a pharmacy are administered by our Pharmacy Benefit Manager (PBM).
In order to promote the usage of generic prescription drugs to reduce costs while maintaining the quality of care, the Pharmacy Benefit Manager (PBM) will automatically substitute an approved generic drug for prescriptions written for multi-source brand name drugs, except for a list of narrow therapeutic index agents, e.
These benefits are administered by our Pharmacy Benefit Manager (PBM).
The Contractor shall not keep a spread between what the Contractor and its Pharmacy Benefit Manager (PBM) pay and what any participating pharmacy receives on any prescription drug claim dispensed to a Member.
The determinations will be relayed to the Pharmacy Benefit Manager (PBM) who will provide the results to a panel consisting of the Plan Administrator and the Union Presidents and/or their agents or designees.

More Definitions of Pharmacy Benefit Manager (PBM)

Pharmacy Benefit Manager (PBM) means the company under contract with the Laborers Health and Welfare Trust Fund for Northern California and who administers the Direct Payment Plan’s prescription Drug benefits. The Fund’s PBM is OptumRx.

Pharmacy Benefit Manager (PBM) means a third-party administrator of prescription drug programs as stated in Insurance Article, §15-1601, Annotated Code of Maryland.

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

Pharmacy Benefit Manager (PBM) means a person or entity that performs pharmacy benefit management, including a person or entity in a contractual or employment relationship with a person or entity performing pharmacy benefit management for a health benefits plan. (7170) “Pharmacy claims file” means a data set containing service level remittance information from all adjudicated claims including, but not limited to, enrollee demographics, provider information, charge and payment information, and national drug codes for an Oregon resident as defined in ORS 803.355 or a non-Oregon resident who is a member of a PEBB or OEBB group health insurance plan.

Pharmacy Benefit Manager (PBM) means an organization that provides administrative services in processing and analyzing prescription claims for pharmacy benefit and coverage programs.

Pharmacy Benefit Manager (PBM) means the company contracted by OHCA to manage pharmacy networks, formularies, drug utilization reviews, pharmacotherapeutic outcomes, claims and/or other features of a pharmacy benefit.

Pharmacy Benefit Manager (PBM) means the representative designated by DHHS to administer the prescription plan for the Title XIX population.