Tear It Down, Build It Right: What a Truly Transparent PBM Looks Like

Recently, I had the opportunity to sit down with Breck Rice of ServRx on the PBM Reform Podcast—a conversation that felt both overdue and energizing. We covered everything from my roots in community pharmacy to the big, structural problems that plague today’s legacy pharmacy benefit manager (PBM) model. Most importantly, we talked about what transparency really means in a space where the term gets thrown around a lot but rarely delivered on.

If you care about fixing the incentives in pharmacy, supporting independent pharmacies, or just making sure patients aren’t overpaying for their prescriptions, I encourage you to give it a listen.

Listen to the full episode here.

In the meantime, here’s a deeper look at some of the themes that stood out from our conversation—and why they matter.

From Behind the Counter to Behind the Curtain

Before SmithRx, I was a pharmacist. I worked at Smith’s Food & Drug (ironically no relation to SmithRx) in Salt Lake City, which eventually became part of the Kroger family. It’s where I learned the real-world impact of pharmacy decisions on everyday people—neighbors who would walk in needing help, guidance, and often, some creativity in affording their medications.

I went on to get my PharmD and MBA from Idaho State, driven by a realization that clinical knowledge is only part of the equation. If we want to make the system better, we also have to understand the levers driving cost and access—many of which live deep inside the business of pharmacy.

That business side, I came to learn, was badly broken.

Seeing the Problem Up Close

When I joined a transparent PBM early in my career, I saw the potential. We built simple, pass-through contracts. Employers trusted us. But when we were acquired by a legacy PBM, everything changed.

Suddenly, our fair contracts were seen as margin opportunities. Instead of focusing on getting the best price for clients, the focus shifted to maximizing spread, pushing claims through higher-cost channels, and manipulating rebate flows. We were told to lean on the old pharma scapegoat when spend went up—but I knew the truth. We were the problem.

That moment was the turning point for me.

Rebuilding a PBM the Right Way

SmithRx was born from a desire to build a PBM that does what PBMs were originally designed to do: lower costs and improve access through efficiency and smart navigation—not by extracting hidden margins from the people we’re supposed to serve.

Transparency, to us, means:

• Every employer gets the same pharmacy pricing—no hidden tiers, no backroom deals.
  
• Every manufacturer rebate, admin fee, and incentive goes back to the client. We don’t take a cut.
  
• Employers get access to all their data, from raw NCPDP claims to real-time rebate reports.

We don’t just use the word “transparent”—we make it operational.

Technology That Finds the Savings

One of the things we’re most proud of is our Drug Pathways Engine—our internal platform that identifies savings opportunities across every prescription. Whether it’s a lower-cost therapeutic alternative, a more affordable pharmacy, or a patient affordability program, our system flags it. And our patient navigation team helps make the switch happen.

This isn’t about formulary tiering for show. It’s about delivering real, measurable savings and helping patients make informed choices.

A Better Way to Partner with Pharmacies

Pharmacies—especially independents—are too often treated as cost centers rather than care partners. We take a different approach.

Instead of leasing our network from legacy PBMs, we built our own. That allows us to contract directly with community pharmacies and offer fair, predictable reimbursement. In fact, in some rural towns, we’ve worked with employers to offer slightly higher reimbursements to keep local pharmacies open. And those employers were more than willing to do it—because they understand the value.

Too many pharmacies are closing—one per day, by some reports. If we don't change how PBMs treat these providers, that number will only grow.

A Call for Grassroots Reform

There’s a lot of talk in Washington about PBM reform. I’m glad it's happening—but real change won’t come just from legislation. It will come when employers demand better and modern PBMs step up to deliver it.

That’s why conversations like the one I had on the PBM Reform Podcast matter. Because when we talk openly—about incentives, about pricing games, about the truth behind the curtain—we give employers, pharmacists, and patients the tools they need to advocate for something better.

Catch the full conversation here.

If you’re an employer, consultant, pharmacy, or plan sponsor looking for a better way, let’s talk. If you’re a pharmacy that doesn’t feel fairly treated by SmithRx—we want to hear from you. Our model only works if it works for everyone.

Let’s rebuild this thing the right way.