Illinois Health Insurance Practice Exam 2026 – All-in-One Guide to Master Your Health Insurance Certification!

The primary role of a pharmacy benefit manager (PBM) revolves around managing and negotiating pricing for prescription drug benefits. PBMs serve as intermediaries between insurance companies, pharmacies, and drug manufacturers. Their primary function includes creating and maintaining a formulary, which is a list of covered drugs, and negotiating discounts and rebates from pharmaceutical manufacturers to lower overall drug costs for health plans and their members.

By negotiating these favorable terms, PBMs help to control prescription drug spending, ensuring that health plans can offer competitive benefits to consumers while also managing the costs associated with providing those benefits. This function is critical in the healthcare system as it impacts both the affordability of prescriptions for patients and the overall expenditures for healthcare payers.

The other options, such as providing medical advice to patients, ensuring medication access for all patients, or administering healthcare services, do not accurately describe the primary responsibilities of PBMs. Instead, these functions may fall under the purview of healthcare providers or other entities in the healthcare system.