Impact of Pharmacy Benefit Manager Organizations on Diabetes Management
Year: 2026
Type: editorial
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.
Authors: Irl B. Hirsch, Christopher G. Parkin, Kenneth Moritsugu, Grazia Aleppo, George Grunberger, Janet B. McGill, Viral N. Shah, Carol J. Levy, Marissa Bowdler, Bruce Taylor, Thomas C. Blevins, Davida F. Kruger, Guillermo E. Umpierrez, Rachael Hiday, Steve V. Edelman, David G. Marrero, Richard M. Bergenstal
Institutions: University of Washington, Northwestern University, Grunberger Diabetes Institute, Washington University in St. Louis, Indiana University Indianapolis, Indiana University School of Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, Indiana University Health, Berry Consultants, LLC (United States), Texas Diabetes & Endocrinology, Henry Ford Health, Henry Ford Hospital, Emory University, University of California San Diego, University of Arizona, HealthPartners
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7204470830