PBMs: Friends or Foes?
Healthcare Unfiltered
00:00
The Role of Evidence in Negotiating Drugs
Insurance companies do consider cost effectiveness and things like that when they're thinking about what to cover. The other thing that also really matters here is what are the rules for the different group that you're dealing with? So if we're thinking about how PBM's work in the Medicare Part D benefit, there are protected classes of drugs where there's no allowance for formula exclusion. For cancer drugs, for example, you can't exclude any of those from the Medicare PartD benefit.
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