PBM (pharmacy benefit manager)

Definition

The middlemen who set what a pharmacy is paid for each prescription it fills.

Why It Matters

They hold the pricing power in this trade. Reimbursement terms, network access, and the fees above all flow from them, so the contracts and the mix decide whether the revenue is durable or merely current. Ask which plans drive the volume and what share of scripts each represents, because losing one network can take a fifth of the business overnight, and the decision will not be yours to appeal.