04/18/2025
🚨PBM: Mission Failed - Employers, It's Time to Act.
For years, Pharmacy Benefit Managers (PBMs) have promised to reduce costs and improve healthcare access. Instead, they’ve been creating a profit machine that directly harms both your business and employees.
Here’s the reality employers face:
Opaque Pricing Models: PBMs conceal the true cost of medications, inflating prices while promising discounts they don't pass on. This increases your healthcare costs and forces employees to pay more at the pharmacy counter.
Vertical Integration & Conflicts of Interest: PBMs often own the pharmacies they steer employees to, creating a conflict of interest that limits competition and drives up prices. This practice forces your employees to use PBM-affiliated pharmacies instead of more affordable, local options.
Rebate Games: PBMs profit from rebates while employees face higher out-of-pocket costs. The rebates PBMs negotiate with drug manufacturers rarely benefit the companies that pay for insurance—employers. Instead, PBMs pocket them.
Lack of Transparency: PBMs hide critical financial data, leaving employers in the dark about where their money is going. You’re paying more for drugs while PBMs keep the savings for themselves.
Fiduciary Responsibility at Risk: As a plan sponsor, you are legally obligated to act in the best interests of your employees. Allowing PBMs to operate unchecked violates this duty and exposes your organization to legal risks.
The PBM Market is Broken.
With three PBMs controlling 80% of the market, it's time for employers to step up and demand reform.
Here’s what you can do:
Audit PBM Contracts: Demand transparency and clear definitions in your PBM agreements.
Pursue Value-Based Drug Management: Push for pricing models that emphasize value, not just rebates.
Support Legislation: Advocate for PBM reform at the state and federal levels to ensure more transparency and fair practices.
By taking action, employers can finally break the cycle of inflated drug prices and start saving money, all while improving access to affordable medication for employees.
Let’s turn the tide together. It’s time for PBM reform.