Funding models
PBM (Pharmacy Benefit Manager)
A company that manages prescription drug benefits, negotiating with pharmacies and drug manufacturers, processing pharmacy claims, and maintaining formularies. Major PBMs include Express Scripts, CVS Caremark, and OptumRx.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
More in Funding models
Fully-insured plan
Carrier takes claims risk. Fixed premium.
Self-funded (self-insured) plan
Employer pays claims directly. Stop-loss limits risk.
Level-funded plan
Hybrid self-funded with stop-loss. Year-end refund possible.
Stop-loss insurance
Caps employer exposure on catastrophic claims.
Specific stop-loss
Caps individual-claimant exposure.
Aggregate stop-loss
Caps total annual group claims.
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