How PBMs Went From Solution to Problem

If we could buy drugs directly from the manufacturer, it would probably be a whole lot less expensive. And that's how it used to work.

PBMs didn't always exist. Manufacturers made drugs and sold them to pharmacies. You walked into a pharmacy and paid cash for whatever medication you needed. Simple, straightforward, direct.

When Complexity Created Opportunity

As drug prices climbed and insurance coverage expanded, the system grew complicated. PBMs were created to help by building pharmacy networks, establishing standardized pricing, and determining coverage.

At first, this served a real purpose. But PBMs realized their position in the middle of every transaction gave them leverage.

The Middleman Advantage

Today, nearly every prescription runs electronically through PBM systems. When you fill a prescription, the PBM determines what the pharmacy charges.

Here's how pricing works: There's the AWP (average wholesale price) and the actual acquisition cost (what the pharmacy pays). The manufacturer has already been paid. Between the pharmacy's cost and the AWP sits profit that flows to the PBM.

PBMs pressure pharmacies on pricing because forcing down what they pay increases their markup to plan sponsors. Many pharmacies accept whatever reimbursement the PBM offers, sometimes at a loss.

This isn't sustainable for anyone except the middleman.

A Different Approach

DisclosedRx operates as The Fiduciary and Fully Disclosed PBM®. We're contractually bound to act in your best interests.

100% pass-through pricing – You pay what we pay for medications

100% pass-through rebates – You receive every rebate we receive

Single admin fee – One straightforward fee, no hidden revenue streams

We retain 25% of the savings we generate while you benefit from 75%, delivering a 200% ROI. Combined with our admin fee, these are our only two revenue streams.

Our enhanced specialty programs can reduce costs by up to 75% per fill while often eliminating member copays entirely.

The Return to Simplicity

We can't eliminate PBMs from today's system. But we can return to their original purpose: serving plan sponsors and members rather than extracting value from them.

DisclosedRx provides the PBM services you need with Full Disclosure of every financial detail. You deserve to know exactly what your drug costs are, where your rebates go, and that your PBM partner is working for you and no one else.

It's all in the contract.

DisclosedRx – The Fiduciary and Fully Disclosed PBM®