Brokers Who Understand Pharmacy Are Becoming Indispensable

Pharmacy benefits used to be an afterthought.

Medical claims grabbed everyone's attention, and pharmacy was handled quietly in the background.

No longer.

Pharmacy spend is increasingly where employers get caught off guard. A handful of specialty prescriptions can move an entire pharmacy budget, and many employers have little visibility into why.

Specialty drugs represent roughly 45% of plan spend, yet only 1-2% of members use them.

PBM contracts are notoriously difficult to read. While employers believe they understand how pricing and rebates work, they are increasingly turning to brokers for deeper explanation.

What Brokers Are Up Against

Pharmacy benefit structures are built with layers, and each one carries financial weight.

• Rebates are payments manufacturers make to PBMs in exchange for favorable formulary placement. In a traditional PBM arrangement, those rebates are often kept by the PBM rather than passed back to the plan.

• Spread Pricing is the difference between what a PBM charges the plan and what it actually pays the pharmacy. The plan pays more; the PBM keeps the difference. Many employers never see it.

• Formulary Decisions determine which drugs are covered and at what cost to the member. When a PBM controls the formulary without Full Disclosure, those decisions may reflect the PBM's financial interests more than the plan's.

• Channel Management refers to where and how a prescription is filled, whether at retail, mail order, or specialty pharmacy. The channel chosen affects cost significantly, and without visibility, plans often pay more than necessary.

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Employers rely on their brokers to make sense of all of this.

Brokers who can explain what's happening inside a PBM contract are genuinely valuable to their clients.

How DisclosedRx Supports the Broker Community

DisclosedRx is The Fiduciary and The Fully Disclosed PBM®, contractually obligated to act in the best interests of each client. Here's how that structure supports brokers directly:

Actionable Reporting Before You Even Commit Submit 12 months of claims data and receive a Missed Generic Opportunities report, identifying where brand medications should have been dispensed as generics. Brokers use this to negotiate better terms with a client's current PBM without changing vendors.

Savings Guarantees in Writing DisclosedRx includes savings guarantees directly in the contract. If the savings don't materialize, they write a check for the difference. This kind of accountability protects the broker's reputation and gives employers confidence in the recommendation.

No Gag Clauses. No Audit Restrictions. Brokers and clients have real-time access to their own claims data, including exactly what is paid to pharmacies versus what the plan is billed. Full Disclosure is in the contract.

Proactive Member Advocacy Through the Savings Program, DisclosedRx reaches out proactively to members on high-cost specialty medications to help them find lower-cost options, such as international sourcing or manufacturer assistance programs. Brokers and HR teams don't have to quarterback those conversations.

Fiduciary Alignment Because DisclosedRx is contractually and ethically bound to act in each client's best interest, brokers can fulfill their own CAA fiduciary responsibilities with confidence. There is no misalignment between what the PBM earns and what the client needs.

Clean Implementation PBM transitions are often disruptive. DisclosedRx provides a seamless implementation process designed to keep the broker's relationship with the employer intact throughout the change, with minimal disruption to members.

Pharmacy benefits are one of the more complex pieces inside an employer health plan, and the complexity has been used to obscure costs for a long time.

Brokers who understand how the structure works, and who partner with a PBM that operates with Full Disclosure, are the ones employers will turn to first.

DisclosedRx operates as The Fiduciary and The Fully Disclosed PBM®, providing employers and their advisors with complete visibility into pharmacy benefit costs.

See how we’re different: https://www.disclosedrx.com/