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Fiduciary PBM Management: Why Scale Doesn't Equal Savings

Employers have long believed they need massive PBM purchasing power to secure meaningful pharmacy savings. This assumption has allowed traditional PBMs to justify complex pricing schemes and formulary manipulation while claiming these practices are necessary for better rates.


Companies switching to fiduciary PBM management achieve 30-60% savings, demonstrating that ethical management matters more than volume.


Every Decision Serves Your Interests


A Fiduciary PBM is contractually bound to act in the best interest of the plan and its members. This eliminates the conflicts of interest that drive up costs in conventional arrangements.


DisclosedRx operates with complete simplicity: clients pay a flat fee per claim, period. Every other decision prioritizes plan and member savings over PBM profits. When your PBM's success depends on your success, the incentives finally align correctly.


The Numbers Don't Lie


Companies routinely save 40% over big three PBM pricing when switching to DisclosedRx. Fully insured clients often see 50-60% first-year savings. One recent client reduced pharmacy spend by 60% without changing their drug mix, simply by eliminating profit centers built into traditional PBM pricing.


These aren't outliers. They're the natural result when PBMs stop playing financial games and focus on genuine cost control.


How Rebates Drive Up Your Costs


Rebates exist because PBMs created influence peddling with drug manufacturers. Drug companies pay PBMs kickbacks—called rebates—to favor more expensive medications on formularies.


Here's a simple example: Humalog insulin costs $1,000 per fill with a $250 rebate, netting $750 to the plan. Eli Lilly makes an identical unbranded version—insulin aspart injection, literally the same drug with a different label—for $400 with no rebate.


Basic math: $400 is less than $750. Yet traditional PBMs consistently pushed the expensive option because rebates enhanced their profits. Members on high-deductible plans pay the inflated price until reaching their deductible, making this system particularly harmful.


Full Disclosure Changes Everything


Many PBMs now claim rebate pass-through, but surface changes don't address fundamental misalignment. True fiduciary management requires contractual commitment to client interests, complete rebate pass-through, and open formulary control.


DisclosedRx operates as The Fiduciary and Fully Disclosed PBM®, passing 100% of rebates to clients with no additional revenue sources. Complete cost visibility replaces pricing games.


Better Outcomes for Plans and Members


Fiduciary management transforms the member experience. Without incentives to steer toward expensive options, we focus on the right medication at the right cost with excellent Member Service. This often means zero-dollar copays for specialty medications while delivering up to 75% plan savings.


Your Choice: Partner or Profit Center


Traditional PBMs operate as profit centers, generating revenue through schemes that increase your costs. Fiduciary PBMs function as partners, contractually bound to prioritize your interests over their profits.


For employers ready to move past the false promise that scale equals savings, fiduciary management offers proven results: ethical management and Full Disclosure deliver superior outcomes without requiring massive volume.


When your PBM succeeds only when you succeed, everyone wins—except the middlemen profiting from unnecessary complexity.


DisclosedRx operates as The Fiduciary and Fully Disclosed PBM®, providing complete cost visibility and contractual commitment to act in your best interests.


🎙️We spoke about this in detail (and more!) on the Gott’s Gulch podcast recently.



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