Most pharmacy benefit management contracts are designed to benefit the PBM. Here's what a different model looks like.

Most pharmacy benefit management contracts are designed to benefit the PBM. Here's what a different model looks like.

PBM reform has been a topic in healthcare policy circles for years. The reasons are well-documented: spread pricing, rebate retention, formulary manipulation, and conflicts of interest from vertical integration.

What's less commonly discussed is that there's an alternative — and it's already operating at scale.

MDR's partner is a nonprofit Medical Benefit Manager (MBM) — the first organization operating in that class of trade — that has built its model explicitly around eliminating the misaligned incentives in traditional PBM arrangements.

What that looks like practically:

Pharmacy is reimbursed based on actual acquisition cost — not a spread that benefits the PBM. Clients can verify what was actually paid to the pharmacy.

100% of rebates go to the client, processed monthly through their proprietary Robo-Rebate system. There's no opacity about what rebates were generated or where they went.

Formulary decisions are made based on clinical and economic merit, not on which manufacturer has the best rebate arrangement.

For self-insured employers, health plans, and government entities: the question isn't whether you're overpaying under your current PBM arrangement. It's by how much — and whether you have the visibility to know.

When did your organization last conduct an independent audit of your PBM arrangement?