Pharmacy and PBMs. Where drug dollars go.
How pharmacy benefit managers are paid and how to read their contracts: spread pricing, rebates, formularies, specialty drugs and PBM reform.
Start with the main guide
How to choose a PBM
To choose a good PBM, an employer should compare contracts, not just price quotes. Check how brand, generic and specialty drugs are defined, what share of rebates reaches your plan, whether spread pricing is allowed, and your audit, data and termination rights. A standardized, scored RFP makes the bids comparable.
Read the guideIn this guide
- What does a PBM do for your plan?
- Why does the contract matter more than the quote?
- The contract terms to check first
- What questions should you ask every PBM?
- What are the red flags in a PBM bid?
- How does a PBM RFP work at Ethos Benefits?
- What does federal law now require of PBMs?
Guides 3
Insights 4
See what your plan is really costing you.
A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.