The Application Of Pharmacy Benefit Management In Our Medical Insurance And Commercial Health Insurance

The United States was one of the nations which implemented the marketization of medical insurance early on. By the development of medical insurance, American people found that they could not control their soaring medical costs, and they should make decisions among too many choices when they wanted to be insured. The US wanted to improve their insurance market performance on operation, management and supervision. In this case, Pharmacy Benefit Management (PBM) was born.PBM is a kind of professional third-party service. By using the market methods, PBM can manage the cost of medicine. The core purpose of PBM is promoting the utilization of medical insurance fund. As third-party companies, Pharmacy Benefit Management Companies (PBMs) need to balance the interests of various parties including government, insurance company, the manufacturer and patients. They appear in every spot of the whole medical supply chain, provide services including formulary management, drug mail-order service, prescription processing,drug utilization evaluating and disease management. The development of PBM has a significant impact on the market-oriented insurance system of American.Currently, China is also facing the difficulties of soaring health care expenses, and the medical market situation is very similar to the situation of the United States in the past. Two problems need to be solved in China, one is to create the perfect universal social health insurance system, and the other is to seek the development space and development path of commercial health insurance.Although the pharmacy benefit management model has emerged in the medical insurance and commercial health insurance of our country, the application is only certain parts separated from each other. Learning and applying the PBM model is necessary, but in the actual situation of our country, there are still many constraints and problems if we want to develop PBM model. The article firstly gives a detailed description of the knowledge of the pharmacy benefit management model, then analysis the necessity of learning the model. According to the PBM model’s current application in China, the article explores the possible problems when applying the PBM model and puts forward personal suggestions about dealing with the problems. I hope that it can exert a positive effect on the application of PBM model in our country, even improve our health care system, and promote the development of China’s commercial health insurance, etc.