Pharmacy Costs Are Exploding — Employer Benefits Decision Journey
Our pharmacy costs are exploding.
Pharmacy is now the fastest-growing cost driver in employer health plans — driven by specialty drugs, PBM spread pricing, and inadequate rebate pass-through. This journey takes you from diagnosis to action.
The problem
Specialty drugs now represent 40–50% of pharmacy spend for most employers — and PBMs profit from opacity. Spread pricing, retained rebates, and formulary manipulation cost employers an estimated $5–15 PEPM in hidden fees.
The outcome
A quantified savings opportunity, a graded assessment of your current PBM program, an AI review of your contract terms, and a shortlist of PBM alternatives — with a clear negotiation strategy.
6 steps · Free · No login required to start
Your step-by-step plan
PBM Learning Track
Understand how PBMs make money, what spread pricing is, how rebates work, and what a good PBM contract looks like. You can't negotiate what you don't understand.
Already familiar with PBM mechanics? Skip to step 2.
PBM Savings Calculator
Quantify your savings opportunity across generic fill rate, mail order, specialty management, spread pricing, and rebate pass-through. Most employers find $50–200 PEPM in recoverable savings.
PBM Analysis™
A 15-question graded assessment of your pharmacy program. Identifies specific weaknesses in your formulary design, specialty management, and contract terms.
PBM Contract IQ™
Upload your current PBM contract and get an AI-powered scoring of your terms against market benchmarks. Identifies red flags, missing protections, and negotiation leverage points.
Compare PBM Vendors
See how alternative PBMs compare on rebates, spread pricing, specialty management, and formulary design. Use your contract review findings as your evaluation criteria.
Specialty Strategy Resources
Specialty drugs are the #1 PBM cost driver. Learn about carve-outs, white-bagging, biosimilar substitution, and specialty pharmacy networks — and how to negotiate them into your contract.
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