CORE Pharmacy

04/18/2025

Employers: It’s Time to Confront the Truth About Your PBM Contract.

The vast majority of employers are unknowingly overpaying for prescription benefits—while Pharmacy Benefit Managers (PBMs) extract massive profits from opaque, misaligned, and self-serving practices.

According to the National Alliance of Healthcare Purchaser Coalitions:

Three PBMs control over 80% of the prescription market—CVS Caremark, Express Scripts, and OptumRx.

These PBMs benefit when drug prices increase, favoring high-rebate drugs over lower-cost generics and biosimilars.

Contracts are filled with gag clauses, spread pricing, and revenue streams PBMs don't disclose.

Many brokers and consultants advising employers receive compensation from PBMs—presenting serious fiduciary concerns under the Consolidated Appropriations Act.

The result? Employers pay more. Employees face rising out-of-pocket costs. And your plan subsidizes the PBM’s bottom line—not better health outcomes.

If you're not actively auditing your PBM, owning your claims data, and demanding full transparency, you are likely violating your fiduciary duty—and leaving significant savings on the table.

Now is the time to act:

Conduct a full PBM contract review.

Eliminate embedded conflicts of interest.

Demand drug-level rebate data and utilization transparency.

Align your pharmacy benefits with your financial and employee health goals.

This isn’t about disruption for its own sake. It’s about restoring value, trust, and accountability to your benefit plan.

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.

04/14/2025

04/10/2025

🚨 FTC REPORT CONFIRMS: PBMs ARE FAILING PATIENTS & PHARMACIES 🚨

The FTC's second report exposes the troubling reality of PBM practices:

DIVERTING billions in manufacturer rebates instead of lowering patient costs

EXPLOITING "spread pricing" to inflate medication prices

FORCING patients into their own specialty pharmacies while RESTRICTING patient choice

IMPLEMENTING predatory reimbursement that threatens community pharmacy survival

DESIGNING formularies based on profit—not patient needs or clinical evidence

These practices aren't just business decisions—they're harmful policies that create barriers to care, increase costs, and jeopardize our healthcare system.

Our patients deserve better. Our communities need action. The evidence is clear.

Time for meaningful PBM reform NOW.

02/25/2025

This is a real problem and a major concern. We are an industry that doesn’t get reimbursed for labor, underpaid on many prescriptions, and full of regulatory oversight that makes most people dread going to the pharmacy. The understaffed pharmacies has more to do with cash flow than it does finding help.
One example of reimbursement is a 90-day supply of generic cholesterol medication. We received a total of $1.99. My take on that is that I can not even get an iced tea at dinner for that reimbursement. However, the PBM will bill your insurance an inflated price of $15-20 and pocket the difference.
A new tactic by the PBM is to charge the patient more at the cash register, but take back $7.50-$10 from the pharmacy. So, now they are passing more price inflammation on to the patient. Yet, then charging your insurance an inflated price to double dip on the profit.

Please reach out to your local elected officials at the state and federal level to express your concerns about the loss of pharmacies. Illinois is already seeing pharmacy deserts.

02/24/2025

Ready to make a change? Try a local pharmacy. Not only do we take most insurances, but we also provide the best cash prices. We can transfer your prescriptions with a simple phone call to us.

02/24/2025

Struggling with recovery from the latest rounds of illness? Wanting to boost your immune system before the illness catches up with you? Book your appointment now!

02/20/2025

Here at Core Functional we are continuing to offer patients many options to their health problems. Call to schedule your appointment.

02/19/2025

We will have a late start this morning. We will try to be in at 9am this morning.

02/16/2025

We are so happy to announce the newest addition to our Core Community of Health. Core Functional Health is a career-long dream of Erik's to provide the option for better health and well-being through functional healthcare. Continue to follow us to see the many new and great options we have planned for the future of Core Community of Health.

01/10/2025

We have closed for the afternoon. We will be back Saturday from 9-12.