PBM (Pharmacy Benefit Manager)

Definition

A middleman company that administers the prescription-drug benefit for an insurer or employer, including formulary design, prior-authorization criteria, pharmacy network contracts, and rebate negotiations with manufacturers. The three largest US PBMs (Express Scripts, CVS Caremark, OptumRx) control ~80% of the market and meaningfully shape GLP-1 access.

Prior-auth success criteria →

Definition curated by Weight Loss Rankings — sourced from FDA labels and peer-reviewed PubMed literature, never AI-generated summaries.

Related terms in insurance

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

Looking for more depth?

• Prior-auth success criteria
• Browse the full GLP-1 glossary (124 terms across 8 categories)
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