Impact of Pharmacy Benefit Manager Organizations on Diabetes Management.
Recommended Citation
Hirsch IB, Parkin CG, Moritsugu K, Aleppo G, Grunberger G, McGill JB, Shah VN, Levy CJ, Bowdler M, Taylor B, Blevins TC, Kruger DF, Umpierrez GE, Hiday R, Edelman SV, Marrero DG, Bergenstal RM. Impact of Pharmacy Benefit Manager Organizations on Diabetes Management. J Diabetes Sci Technol. 2026;19322968261480168.
Document Type
Article
Publication Date
8-27-2026
Publication Title
J Diabetes Sci Technol
Abstract
Pharmacy benefit managers (PBMs) administer prescription drug benefits for insurers, employers, and other payers through formulary design, rebate negotiation, pharmacy network management, and utilization controls. In diabetes care, cost-containment strategies such as formulary-driven medication switching, step therapy, and formulary exclusivity have increasingly restricted access to essential medications and technologies. These rebate-driven practices often prioritize financial incentives over clinical appropriateness, leading to forced nonmedical switching, higher out-of-pocket costs, reduced adherence, and poorer glycemic outcomes. This narrative review examines how PBM-driven policies undermine patient-centered, evidence-based diabetes care and disrupt continuity of treatment. Greater transparency, preservation of patient and clinician choice, and policies that align PBM incentives with clinical outcomes are needed to reduce harm and improve access to appropriate diabetes therapies.
PubMed ID
42661143
First Page
19322968261480168
Last Page
19322968261480168
