Pharmaceutical Benefits within Health Insurance Plans: U.S.

This entry deals with pharmaceutical benefits within health insurance plans in the United States and describes the basic components of pharmaceutical benefits and plan features that are designed to control costs and focus medically appropriate benefits on those in need. The first section outlines how the pharmacy benefit is delivered as part of a health plan and in relation to pharmacy benefit managers and pharmacies. The second section outlines the basic components of drug approvals (excluding the U.S. Food and Drug Administration [FDA] process) for plan consideration. This section is followed by a description of plan features aimed at the decision making of providers and patients. Pharmacy benefit management is further described as are the intended and unintended consequences of pharmacy benefit design and management ...

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