PBM Core Activities include which elements?

PBM Core Activities include which elements?

• A. Marketing campaigns
• B. Benefit design, pharmacy networks, claims processing, rebates, clinical services
• C. Surgical scheduling
• D. Lab testing

Answer: (B)

Managing the pharmaceutical benefit centers on balancing cost, access, and quality of care. The core activities include designing the benefit (formulary and tier structure, member cost sharing, prior authorization, and step therapy), building and managing a network of pharmacies, processing and adjudicating claims, negotiating rebates with manufacturers, and delivering clinical services that optimize medication use (such as medication therapy management, adherence programs, and drug utilization reviews). Marketing campaigns are not part of these program-management functions, and surgical scheduling or lab testing pertain to clinical/operational activities outside the PBM’s core scope.

Managing the pharmaceutical benefit centers on balancing cost, access, and quality of care. The core activities include designing the benefit (formulary and tier structure, member cost sharing, prior authorization, and step therapy), building and managing a network of pharmacies, processing and adjudicating claims, negotiating rebates with manufacturers, and delivering clinical services that optimize medication use (such as medication therapy management, adherence programs, and drug utilization reviews). Marketing campaigns are not part of these program-management functions, and surgical scheduling or lab testing pertain to clinical/operational activities outside the PBM’s core scope.