The Ultimate Pharmacy Benefits Manager Evaluation Guide

A Comprehensive Resource for Assessing and Choosing the Best PBM

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Problems with Big Health and Legacy PBMs

Did you know? The big three PBMs—Express Scripts, CVS Caremark, and Optum Rx—control around 80% of the U.S. prescription drug market. With their influence through group purchasing organizations (GPOs), their combined control nears 100%, leading to widespread issues.

Spread Pricing

Legacy PBMs charge health plans more for a drug than they reimburse pharmacies, keeping the difference as revenue. This "spread" varies based on the drug, pharmacy, and contract terms.

Rebate Take

Legacy PBMs retain a portion of manufacturer rebates instead of passing them to plan sponsors. This practice incentivizes PBMs to favor drugs with higher rebates, undermining cost savings.

Vertical Integration

Legacy PBMs expand control by acquiring insurers, pharmacies, or manufacturers. This leads to higher drug prices, limited consumer choices, and reduced pricing transparency.

Spread Pricing

Legacy PBMs charge health plans more for a drug than they reimburse pharmacies, keeping the difference as revenue. This "spread" varies based on the drug, pharmacy, and contract terms.

Rebate Take

Legacy PBMs retain a portion of manufacturer rebates instead of passing them to plan sponsors. This practice incentivizes PBMs to favor drugs with higher rebates, undermining cost savings.

Vertical Integration

Legacy PBMs expand control by acquiring insurers, pharmacies, or manufacturers. This leads to higher drug prices, limited consumer choices, and reduced pricing transparency.

This guide will help you

Understand the Evolution of PBMs

Gain a comprehensive understanding of the history and development of legacy PBMs, and how their practices have impacted the market over time.

Evaluate PBMs Effectively

Learn how to assess today’s PBMs based on cost-effectiveness and performance, moving beyond discount-based evaluations to focus on total cost savings and transparency.

Access Essential Resources

Utilize a glossary of key terms and pricing analyses to estimate potential savings and navigate the complexities of PBM contracts with ease.

Make Informed Decisions

Discover strategies for identifying hidden fees and complex rebate structures, empowering you to choose a PBM that aligns with your goals and values.

Optimize PBM Selection Today

At SmithRx, we understand the frustration that comes along with evaluating Pharmacy Benefit Managers. Despite the challenges of a broken American healthcare system, effective tools are available to help you navigate the landscape and make cost-effective decisions. Our PBM Evaluation Guide offers a comprehensive overview of the industry's origins, its evolution, and the necessity 
of rethinking current evaluation methods.

Download now