You Wouldn't Share a Lawyer. Why Share a PBM?

Picture this: you are in a car accident. It was not your fault. You need an attorney to represent you.

Someone recommends a lawyer, you do a little research, and they seem solid. Then you find out that same attorney also represents the other driver's insurance company.

Would you still hire them?

Most people say no immediately. Not because the attorney lacks skill, but because their incentives are split.

When one person is paid by both sides, decisions stop being about your best interest and start being about managing the middle.

That is exactly how many traditional pharmacy benefit managers operate.

What's a PBM?

A pharmacy benefit manager, or PBM, is the company that sits between your health plan and the pharmacy.

They process prescription claims, negotiate drug pricing, manage the list of covered medications (called a formulary), and handle rebates from drug manufacturers. Employers and health plans hire PBMs to manage pharmacy costs on behalf of their members.

On paper, the PBM works for you.

In practice, the revenue structure tells a more complicated story.

How Traditional PBM Revenue Actually Works

The employer pays the PBM an admin fee. Most people assume that is where the PBM's revenue ends. It rarely is.

Manufacturer Rebates

Drug manufacturers pay rebates to PBMs in exchange for preferred placement on the formulary. The higher a drug ranks on the formulary, the more members use it.

When a PBM earns more revenue based on which drugs get selected, formulary decisions become tied to financial incentives that have nothing to do with your plan or your members.

Spread Pricing

Spread pricing is the difference between what a PBM charges the employer for a drug and what the PBM actually pays the pharmacy.

The employer pays a higher rate. The pharmacy receives a lower rate. The PBM keeps the difference.

The employer rarely sees this spread itemized anywhere.

Pharmacy Network Fees

PBMs also collect fees from pharmacies that participate in their network.

When a PBM owns or has financial ties to pharmacies inside that network, directing members to lower-cost options outside it costs them revenue.

Supply Chain Credits

Additional credits and fees move through the pharmaceutical supply chain, often collected quietly and rarely disclosed to the employer whose plan generated them in the first place.

When a single entity collects revenue from manufacturers, pharmacies, wholesalers, and employers simultaneously, objectivity is structurally difficult.

What a Fiduciary PBM Looks Like

A Fiduciary PBM is contractually and ethically bound to act in the best interests of its clients. One source of revenue. One set of interests. Full Disclosure of every dollar moving through the plan.

DisclosedRx operates as The Fiduciary and The Fully Disclosed PBM®. Every commitment below is contractually documented:

• 100% rebate pass-through. Every rebate dollar your plan generates comes back to your plan.

• 100% pricing pass-through. You pay what we pay. No spread, no markup.

• Full Disclosure. Complete visibility into drug spend, rebates, and every dollar associated with your plan.

• Single source of revenue. No manufacturer relationships, no pharmacy network fees, no supply chain credits.

  
  

Full Disclosure Changes the Relationship

Full Disclosure is not just a feature. It is a fundamentally different kind of relationship between an employer and their PBM.

When your PBM has no financial reason to steer drug selection, formulary design, or channel decisions in a particular direction, those decisions can actually be made in your interest.

Your plan sees better savings. Your members get better access. No one is collecting fees in the background.

The Question Worth Asking

How many sources of revenue does your PBM collect from?

If the answer is more than one, it is worth understanding exactly who is sitting at the table and whose interests are being served.

DisclosedRx was built to answer that question simply and contractually. One client. One fee. Full Disclosure.