CHAPTER 10Pharmacy Benefits

Craig S. Stern

This chapter focuses on prescription medications used in the ambulatory environment. It discusses the elements of a pharmacy benefit, the role of pharmacy benefit managers, and the role of pharmacy in workers’ compensation.

Historically, pharmacy benefits were packaged with vision and dental plans to complement medical benefits and were sold as “riders” to be added to the major medical package for an additional premium. However, prescription drugs differ from vision and dental care in that the latter are frequently elective and predictable in nature, whereas prescription drugs may be predictable for many chronic conditions but are infrequently elective. Before the 1970s, drug prices lagged behind the ...

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