Magagnoli- Pharmacy Benefit design Page 1
are PBMs incentivized to provide value to patients no!
carve out benefits are promoted as a cost saving measure
carve out pharmacy benefits pharmacy benefits are separate from the core medical benefits
closed formulary only formulary drugs are covered
example of carve-out benefit PBMs CVS caremark, optum RX
Formulary list of preferred drugs in a given setting; manage pharmacy costs
formulary system methodology used to select and curate the formulary
formulary tiering higher up in tier the more cost sharing on the patient
Integrated pharmacy benefits medical and pharmacy package bundled together from a single insurer/vendor
integrated pharmacy benefits pros information sharing over medical pharmacy
improved patient/disease state managment
Magagnoli- Pharmacy Benefit design 2/5/2026
are PBMs incentivized to provide value to patients no!
carve out benefits are promoted as a cost saving measure
carve out pharmacy benefits pharmacy benefits are separate from the core medical benefits
closed formulary only formulary drugs are covered
example of carve-out benefit PBMs CVS caremark, optum RX
Formulary list of preferred drugs in a given setting; manage pharmacy costs
formulary system methodology used to select and curate the formulary
formulary tiering higher up in tier the more cost sharing on the patient
Integrated pharmacy benefits medical and pharmacy package bundled together from a single insurer/vendor
integrated pharmacy benefits pros information sharing over medical pharmacy
improved patient/disease state managment
Magagnoli- Pharmacy Benefit design 2/5/2026
