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Pharmacy Care Services

A new report from UnitedHealth Group, “Pharmacy Benefit Management Can Save Medicaid Drug Programs Over $100 Billion,” finds Pharmacy Benefit Managers (PBMs) are saving Medicaid billions.

Nationally, PBMs saved Medicaid $6 billion in 2016. These savings represent only a portion of the potential savings achievable if all states were to fully utilize PBM tools and capabilities, including:

  • Driving use of the highest therapeutic quality, lowest-cost drugs and shifting utilization from brands to generics as clinically appropriate;
  • Developing preferred pharmacy networks;
  • Advancing evidence-based, clinically effective utilization; and
  • Leveraging data analytics to detect and prevent fraud, waste, and abuse.

Optimal use of pharmacy benefit management in Medicaid could save up to $8.5 billion in 2019. Over a decade, the new savings could exceed $100 billion – a 23 percent reduction in total Medicaid drug spending.

Data for States