PBM (Pharmacy Benefit Manager)

Definition

Pharmacy benefit manager — the middleman running the drug benefit for an insurer or employer: formulary design, prior-authorization rules, pharmacy network contracts, rebate deals with manufacturers. Express Scripts, CVS Caremark and OptumRx control roughly 80% of the US market, which makes three companies the effective gatekeepers of GLP-1 access.

Prior-auth success criteria →

GLP Watchdog writes these definitions from FDA labels and peer-reviewed PubMed literature. Not one of them is an AI-generated summary.

Other terms under insurance

• Copay accumulator
• Specialty pharmacy
• Mail-order pharmacy
• Quantity limit
• Bridge therapy
• Patient assistance program (PAP)
• Manufacturer coupon
• Deductible
• Coinsurance

Where the evidence lives

• Prior-auth success criteria
• The full GLP-1 glossary (149 terms, 8 categories)
• Research articles — written from primary sources
• Tools and calculators
• Compare GLP-1 telehealth providers