Over the past several years, the PBM landscape has shifted significantly—and that rapid shift continues today. What was once considered satisfactory, or part of the status quo, is simply no longer acceptable. And we’re not just talking about industry “buzzwords” that have largely gone the way of the cliché. But let’s start there.
The Fall of “Transparency”
While not a legal term, “transparency” is, without a doubt, one of the most overused, over promised, and severely underdelivered concepts in the health benefits space—but particularly in the PBM world. While anyone can say they’re transparent, or claim to deliver the “most” transparent services, what does that actually mean? Well, that can vary tremendously.
The fact is, it’s all relative. While a PBM can be transparent, that doesn’t mean they have a client’s best interest as their top priority. To put it bluntly, they’re often just open about revenue sources (and claim that to be “total” transparency). For the client, however, that doesn’t mean much at all for their bottom line—as these PBMs can still engage in undisclosed spread pricing, rebate-driven revenue models, and markups.
The Rise and Thrive of Fiduciary
With a marketplace demanding more, fiduciary PBMs—like US-Rx Care—have become the clear alternative to the status quo. For fiduciary PBMs, who are contractually obligated to act in the best interest of every client, transparency, fairness, trust, and accountability aren’t just buzzwords that marketers throw around—they are guarantees.
With the fiduciary model, every dollar spent for PBM services MUST be compliant with these contractual obligations. This means the client’s money is only spent on cost savings and service fulfillment. There are no “gotcha” moments. All compensation sources, including rebates, administrative fees, and other revenue streams are clearly disclosed.
The Water Bill Metaphor
Think of the traditional “transparent” vs. fiduciary PBM argument like your monthly water bill. The bill is transparent in the sense that you can see what your total bill is, but you may not necessarily have insight to where every dollar is going or what you’re ACTUALLY paying for. Think of it as “additional” or “admin” fees. But, regardless, you continue to pay to ensure that you have water to use.
Under a fiduciary contract, you would know for certain that you’re getting the best rate possible and that every dollar you are spending is being used to work in YOUR best interest—not to line the pockets of the water company or pay for things that don’t serve any purpose for you directly.
Building an Effective Fiduciary Strategy
Fiduciary PBMs are important today because they provide a more ethical and cost-effective approach to managing prescription drug benefits, which is crucial for controlling the rising costs of healthcare.
An effective fiduciary strategy means full pass-through pricing (no surprises—knowing where every dollar is going), no spread pricing (charging more for drugs just to make a profit), an alignment of interests between the client and the PBM, along with independent and unbiased formulary management.
The result? TRUE transparency, lower long-term costs, and better health outcomes for patients.
Let ‘s talk about what our unique fiduciary approach at US-Rx Care can deliver for you and your clients!
Reach out: usrxcare.com/contact/