The Conflict Built Into Your Pharmacy Benefit

In a real estate transaction, two people sit across the table from each other with opposite goals. The seller wants the highest price possible. The buyer wants to pay as little as they can.

Now imagine one agent representing both of them at the same time. That agent cannot fully advocate for either party without undermining the other, and someone ends up on the losing side.

Traditional pharmacy benefit managers operate inside the same conflict, and most employers have never stopped to question it.

Who Does Your PBM Work For?

Your PBM negotiates drug prices with manufacturers and pharmacies on one hand, while managing costs for your plan on the other.

Their revenue often depends on:

• Higher list prices that increase what your plan pays

• Rebates retained before they reach you

• Pricing arrangements that make the actual numbers difficult to see

  
  

When a PBM profits from the same variables that drive your costs up, the incentives do not align with your goals. Most contracts do not require them to disclose this.

What a Fiduciary PBM Looks Like

A Fiduciary PBM is contractually and ethically bound to act in the best interests of its clients.

At DisclosedRx, The Fiduciary and The Fully Disclosed PBM®, every financial relationship is spelled out in the contract. There are no side arrangements, no retained rebates, and no pricing spreads working against your interests.

Our two sources of revenue are a single, straightforward admin fee and a 25% share of the savings generated for your plan, with 75% flowing directly back to you. That structure means we only do well when you do well.

Full Disclosure Is the Starting Point

Full Disclosure means you see everything: what drugs cost, what rebates exist, and exactly where every dollar goes.

Most employers have never had that clarity, which makes it difficult to hold a PBM accountable. When you have Full Disclosure, you can make informed decisions, compare costs accurately, and verify that what your PBM says matches what appears in the contract.

The Numbers Should Make Sense to You

Specialty drugs represent roughly 45% of plan spend while only 1 to 2% of members use them. That is a significant concentration of cost in a small population, and it is also where costs are hardest to see clearly.

DisclosedRx specialty programs deliver savings of up to 75% per fill while reducing member copays, often to zero. Those results are difficult to achieve when a PBM benefits from higher specialty costs.

One Question Worth Asking

The next time you review your pharmacy benefit, ask your PBM to show you, in writing, every dollar they earn from managing your plan.

If the answer is complicated or incomplete, that tells you something important.

A Fiduciary PBM gives you a straightforward, contractually obligated answer, because Full Disclosure is not a feature. It is the foundation of how we operate, and it is the only standard worth holding your PBM to.

DisclosedRx operates as The Fiduciary and The Fully Disclosed PBM®, providing employers with complete visibility into pharmacy benefit costs and a contractual commitment to act in their best interests.