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An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices

College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA
Author to whom correspondence should be addressed.
Pharmacy 2019, 7(2), 65;
Received: 29 April 2019 / Revised: 7 June 2019 / Accepted: 11 June 2019 / Published: 14 June 2019
(This article belongs to the Special Issue Pharmacist Services)
PDF [265 KB, uploaded 14 June 2019]


The high costs associated with pharmaceuticals and the accompanying stakeholders are being closely evaluated in the search for solutions. As a major stakeholder in the U.S. pharmaceutical market, the practices of pharmacy benefit manager (PBM) organizations have been under increased scrutiny. Examples of controversial practices have included incentives driving formulary status and prohibiting pharmacists from disclosing information on lower-cost prescription alternatives. Ethical investigations have been largely omitted within the debate on the responsibilities of these organizations in the health care system. Ethical analysis of organizational practices is justified based on the potential impact during health care delivery. The objective of this study was to analyze several specific PBM practices using multiple ethical decision-making models to determine their ethical nature. This study systematically applied multiple ethical decision-making models and codes of ethics to a variety of practices associated with PBM-related dilemmas encountered in the pharmaceutical environment. The assessed scenarios resulted in mixed outcomes. PBM practices were both ethical and unethical depending on the applied ethical model. Despite variation across applied models, some practices were predominately ethical or unethical. The point of sale rebates were consistently determined as ethical, whereas market consolidation, gag clauses, and fluctuation of pharmacy reimbursements were all predominantly determined as unethical. The application of using provider codes of ethics created additional comparison and also contained mixed findings. This study provided a unique assessment of PBM practices and provides context from a variety of ethical perspectives. To the knowledge of the authors, these perspectives have not been previously applied to PBM practices in the literature. The application of ethical decision-making models offers a unique context to current health care dilemmas. It is important to analyze health care dilemmas using ethics-based frameworks to contribute solutions addressing complexities and values of all stakeholders in the health care environment. View Full-Text
Keywords: pharmacy benefit manager (PBM); ethics; pharmaceutical regulation; health care policy; decision-making; organizations; ethical models; code of ethics; pharmacist pharmacy benefit manager (PBM); ethics; pharmaceutical regulation; health care policy; decision-making; organizations; ethical models; code of ethics; pharmacist
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Drettwan, J.J.; Kjos, A.L. An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices. Pharmacy 2019, 7, 65.

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