What is one of the benefits of a PBM carve-out arrangement?

A PBM carve-out arrangement refers to a situation where a health plan separates its pharmacy benefits from its medical benefits and contracts a pharmacy benefit manager specifically for those pharmacy services. One of the primary advantages of this arrangement is the potential for better contract terms.

When a health plan engages a PBM specifically for managing pharmacy benefits, it can negotiate more favorable terms due to the specialized focus of the PBM on medications, formulary management, and cost control strategies. With dedicated management of pharmacy benefits, drug pricing can often be optimized, leading to potential savings for both the health plan and its members. This targeted approach allows the PBM to leverage its expertise in pharmaceuticals to negotiate lower drug prices and implement cost-saving measures such as formulary management, rebates, and more effective use of generics.

In contrast, the other options do not align with the benefits typically associated with a carve-out arrangement. Standard clinical programs may not necessarily improve as a result of the carve-out. Fewer pharmacy options would typically not be a desirable outcome of such an arrangement, as it could limit patient access to medications. Increased costs for patients also contradict the beneficial intent of carve-outs, which aims to control and possibly reduce overall medication spending.