OBJECTIVES: The Affordable Care Act (ACA) was signed into law on March 23, 2010. The ACA was developed to increase affordability and accessibility to health care. The purpose of this review was to provide an overview of the impact of the ACA on pharmacy benefit managers (PBMs) with respect to benefit design changes, healthcare exchanges and challenges. METHODS: PubMed, Google Scholar, APhA and AMCP websites were searched for articles from 2008 to 2013. This timeframe was selected because the ACA became officially recognized in 2010, when signed into law. Keywords used in the search were “pharmacy model”, “affordable care act”, “pharmacy benefit”, “benefit design changes”, “healthcare exchange”, and “outcomes.” Each reference was evaluated against the following inclusion criteria using a step-wise approach; 1) the article included information on formulary changes, healthcare exchanges or projected outcomes 2) the article mentioned benefit designs and pharmacy benefit managers. Articles were summarized based upon publication year, methods and findings. RESULTS: A total of 24 articles were retrieved. Studies show that there will be 25-30 million newly insured patients over 7-8 years as a result of the ACA. PBMs will continue to be interested in increasing coverage of generic products on plan formularies. The number of medications and types of diseases covered through the growth of specialty pharmacy is also projected to increase. Under the ACA exchanges, PBMs are required to confidentially disclose the percent of all prescriptions provided through retail pharmacies and the types of rebates and discounts received. Although challenging, PBMs can expect increases in mergers, creating larger PBM companies. CONCLUSIONS: With an increase in the number of members covered and types of coverage offered, the Affordable Care Act is projected to have positive effects on the growth and expansion of services offered by PBMs. However, PBMs may face challenges accommodating larger populations.