The Effect of Pharmacy Benefit Manager Clinical Programs and Services on Access to Prescription Drug Benefit Coverage

Abstract

This paper provides an overview of the effects of a pharmacy benefit manager's programs and services on access to prescription drug coverage. Coverage is increasingly used by prescription drug benefit plans as a means to reduce the potential for exposure to unnecessary costs of providing the benefit. Certain fundamentals must be adhered to so as to avoid creating unintended and inappropriate barriers to access and an appeals process must be in place. Merck-Medco's development and implementation of its clinical programs and services that involve prescription drug coverage decisions is highlighted.