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Understanding Pharmacy Benefit Management

And How PAI Is Making It Simple for Employers 

Navigating pharmacy benefits can be puzzling, especially when drug prices in our country go up. PAI helps employers and members understand pharmacy benefits and costs.

What are pharmacy benefit managers (PBMs)?

PBMs play a big role in healthcare. A PBM talks about and agrees on drug prices with the manufacturers. PAI’s partnership with our preferred PBM, OptumRx®, makes building it as easy as possible for members to get the drugs and care they need at lower prices. With more than 65 million customers across America, OptumRx helps members by offering better discounts and easier access to the drugs they need. 

PAI Simplifies Prescription Drug Management 

We work with OptumRx and our groups to create a list of covered drugs, called a formulary. Formulary lists all prescription medications that are covered under member plans. We also help decide which group or “tier” drugs belong to on the formulary. 

We also help our members figure out how much their medicines might cost with a special cost-estimation tool from OptumRx. This way, members can feel more at ease managing their medical costs. 

Preferred Drug Lists

A committee carefully checks every medicine in the list of preferred drugs. We want our members to feel confident that the medications they're taking are safe, effective, and as affordable as possible.

As the employer, you can choose drugs that aren't too expensive and fit the company's budget. You can better manage pharmacy benefits by suggesting the use of these preferred medicines. This helps keep costs in check while still giving good healthcare options.

OptumRx’s Online Tools Help Members:

Members and employers can get to OptumRx’s online portal directly from their My Benefit ManagerSM account.

  • Availability of generic drug alternatives
  • View personal prescription history
  • Order prescriptions through mail service delivery
  • View their preferred drug list
  • Access to a drug pricing tool for comparison shopping

Continuing the Member Pharmacy Journey 

Pharmacy benefits can be confusing. Still, it’s important information for employers who are trying to make the employee healthcare experience better. Managing pharmacy benefits ahead of time keeps employees healthy and makes the workplace better and more positive.

Make sure to visit our website’s Products + Services page for more detailed information on our PBM offering.