Complete Employer Guide
PBM Strategy
Pharmacy costs are growing faster than any other component of employer health spending — and PBMs sit at the center of it. Most employers are overpaying by 15–30% because of opaque contracts, hidden spread pricing, and retained rebates. This hub covers everything you need to take control of your pharmacy benefit.
Everything in this guide
From PBM basics to contract negotiation, audit, and vendor selection.
The mechanics of pharmacy benefit management — formularies, networks, rebates, and how PBMs make money.
What a transparent PBM contract looks like and the terms every employer should demand.
How manufacturer rebates work, why PBMs retain them, and how to get 100% pass-through.
What spread pricing is, how to detect it, and how to eliminate it from your PBM contract.
Managing specialty drug costs — the fastest-growing component of pharmacy spend.
How to design a formulary that controls costs without compromising member access.
How to audit your PBM contract and claims data to uncover hidden costs.
How to run a PBM RFP, evaluate responses, and select the right PBM for your plan.
Estimate your pharmacy savings potential from PBM reform.
Step-by-step guide to auditing, negotiating, and managing your pharmacy benefits.
Answers to the most common employer questions about pharmacy benefit managers.
How we evaluate PBM contracts, source pricing data, define transparency criteria, and apply AI analysis — with full transparency on methods and limitations.
The PBM problem in plain English
Spread pricing hides costs
Your PBM charges you $50 for a drug and pays the pharmacy $30. The $20 spread is pure profit — and it's buried in your claims data.
Rebates don't reach you
Drug manufacturers pay PBMs billions in rebates to favor their drugs. Most employers receive only a fraction — the rest stays with the PBM.
Specialty pharmacy is a profit center
PBMs own specialty pharmacies and steer your highest-cost drugs through them at inflated margins. You pay the difference.
See how much you could save
Enter your pharmacy spend and employee count to estimate your savings from PBM reform.
Specialty drug management cut pharmacy spend 41% without disrupting member therapy
A 240-employee healthcare staffing employer used biosimilar step therapy, brown-bagging, and a specialty pharmacy carve-out to cut specialty drug costs from 58% to 37% of total pharmacy spend.
Read the case study31% pharmacy cost reduction through transparent PBM contract
A 150-employee Arkansas distributor audited their PBM contract, found $210,000 in annual spread pricing, and transitioned to a transparent pass-through contract with full rebate visibility.
Read the case studyFree assessment
How does your pharmacy strategy score?
The Benefits IQ Checkup™ screens your plan across pharmacy strategy, plan structure, cost, and compliance — in under 10 minutes.