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Historically, a pharmacy benefit manager (PBM) is a third-party administrator of prescription. drug programs. PBMs are primarily responsible for developing and maintaining the. formulary, contracting with pharmacies, negotiating discounts and rebates with drug. manufacturers, and processing and paying prescription drug claims.
PBB refers to the billing process for services rendered in a hospital outpatient clinic or department. This is the national model of practice for integrated delivery systems where the hospital owns space, and employees support personnel involved in patient care.ome Medicare patients may be covered by their supplemental insurance and will not have to pay more out-of-pocket. Depending on their particular insurance coverage, it is possible benefits may differ for certain outpatient services and procedures at a provider-based, hospital outpatient location.