{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:16:37Z","timestamp":1788182197771,"version":"build-2803163510"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Diabetes Sci Technol"],"abstract":"<jats:p>Pharmacy benefit managers (PBMs) administer prescription drug benefits for insurers, employers, and other payers through formulary design, rebate negotiation, pharmacy network management, and utilization controls. In diabetes care, cost-containment strategies such as formulary-driven medication switching, step therapy, and formulary exclusivity have increasingly restricted access to essential medications and technologies. These rebate-driven practices often prioritize financial incentives over clinical appropriateness, leading to forced nonmedical switching, higher out-of-pocket costs, reduced adherence, and poorer glycemic outcomes. This narrative review examines how PBM-driven policies undermine patient-centered, evidence-based diabetes care and disrupt continuity of treatment. Greater transparency, preservation of patient and clinician choice, and policies that align PBM incentives with clinical outcomes are needed to reduce harm and improve access to appropriate diabetes therapies.<\/jats:p>","DOI":"10.1177\/19322968261480168","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:14:57Z","timestamp":1787886897000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Pharmacy Benefit Manager Organizations on Diabetes Management"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-8417","authenticated-orcid":false,"given":"Irl B.","family":"Hirsch","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine, Seattle, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6838-5355","authenticated-orcid":false,"given":"Christopher G.","family":"Parkin","sequence":"additional","affiliation":[{"name":"CGParkin Communications, Inc., Henderson, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Moritsugu","sequence":"additional","affiliation":[{"name":"First Samurai Consulting, LLC. Sarasota, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1644-5947","authenticated-orcid":false,"given":"Grazia","family":"Aleppo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Grunberger","sequence":"additional","affiliation":[{"name":"Grunberger Diabetes and Endocrinology, Bloomfield Hills, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet B.","family":"McGill","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-7107","authenticated-orcid":false,"given":"Viral N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3492-2578","authenticated-orcid":false,"given":"Carol J.","family":"Levy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, Medicine and Obstetrics, Endocrine Clinical Research, Mount Sinai Diabetes Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Bowdler","sequence":"additional","affiliation":[{"name":"Indiana University Health, Indianapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Taylor","sequence":"additional","affiliation":[{"name":"Bruce Taylor Consulting, LLC, Fishers, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3746-9606","authenticated-orcid":false,"given":"Thomas C.","family":"Blevins","sequence":"additional","affiliation":[{"name":"Texas Diabetes and Endocrinology, Austin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davida F.","family":"Kruger","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Bone and Mineral Disease, Henry Ford Medical Center-New Center One, Detroit, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-5026","authenticated-orcid":false,"given":"Guillermo E.","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Hiday","sequence":"additional","affiliation":[{"name":"Windrose Health Network, Greenwood, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-9332","authenticated-orcid":false,"given":"Steve V.","family":"Edelman","sequence":"additional","affiliation":[{"name":"University of California San Diego, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-7812","authenticated-orcid":false,"given":"David G.","family":"Marrero","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Arizona, Tucson, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9050-5584","authenticated-orcid":false,"given":"Richard M.","family":"Bergenstal","sequence":"additional","affiliation":[{"name":"International Diabetes Center, HealthPartners Institute, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"American Diabetes Association. 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