CPBS

A pharmacy savings strategy can look good on paper and still fail in the claims data.

One of the easiest places to see it is non-formulary spend. The benchmark is called the Formulary Compliance Rate:

Non-formulary drug spend ÷ total net drug spend × 100

If paid non-formulary spend is running above 3%, that should trigger a deeper review of exception approvals, therapeutic classes, reason codes, and whether the P&T committee’s work is being bypassed.

This is not about denying care. Good formulary management still allows fair, clinically appropriate exceptions.

But “access” should not become a shield for poor oversight, rebate-driven decisions, or special handling that undermines the plan’s clinical and financial intent.

A fiduciary standard of care requires employers to know whether the formulary is actually being followed, whether exceptions are documented, and whether coverage decisions are being made in the plan’s best interest.

Why Your Healthcare Savings Strategy is Failing (Hint: Check Your Formulary) TransparentRx If members are routinely filling non-formulary drugs, this is a clear signal why your healthcare savings strategy is failing.

Transparency in pharmacy benefits sounds good, but it means very little if it is not backed by contract authority.

In this post, I asked ChatGPT to score our PBA services agreement for employer control and transparency. The lesson was not the score. The lesson was what changed when fiduciary language, audit rights, rebate ownership, and plan sponsor authority were weakened.

Self-funded employers should ask one practical question:

Does your PBM agreement give you enforceable control, or are you relying on vendor promises?

Read the audit clause. Review rebate ownership. Confirm who controls the formulary, specialty arrangements, network strategy, data access, and plan economics.

That is where fiduciary oversight starts.

I Asked ChatGPT to Score Our PBA Services Agreement and Was Surprised by What I Learned TransparentRx I recently asked ChatGPT to score our pharmacy benefit administrator (PBA) services agreement based on control and transparency.

Buying pharmacy benefits is no longer just a procurement decision. It is a fiduciary responsibility.

In my latest blog, I cover five non-negotiables every PBM purchaser should demand:

• Knowledgeable staff
• Vendor contract access
• Claim data access
• Medical benefit drug claim oversight
• A true fiduciary PBM contract
• Adequate independent resources

For brokers, consultants, CFOs, and HR leaders, the goal is simple: make sure pharmacy benefit decisions are informed, verifiable, and aligned with the best interests of the plan and its members.

Six Non-Negotiables Every Pharmacy Benefits Purchaser Should Demand TransparentRx The wrong internal assumptions can cost a plan millions. Here are six non-negotiables every pharmacy benefits purchaser should demand.

https://transparentrx.com/six-non-negotiables-every-pharmacy-benefits-purchaser-should-demand

Six Non-Negotiables Every Pharmacy Benefits Purchaser Should Demand TransparentRx The wrong internal assumptions can cost a plan millions. Here are six non-negotiables every pharmacy benefits purchaser should demand.

Ticketmaster’s fee backlash offers a useful lesson for employers, brokers, and Benefit Directors: people want clarity, not surprises.

The same standard should apply to pharmacy benefits. When pricing is transparent and contract terms are easy to understand, plan sponsors can make better decisions, manage costs more effectively, and build greater trust with employees.

This is a good opportunity for brokers and Benefit Directors to lead the conversation around transparent pricing, better oversight, and a fiduciary standard of care in pharmacy benefits.

Better visibility leads to better decisions.

What Ticketmaster’s Fee Backlash Can Teach Employers About PBMs TransparentRx Employers do not lose sleep over concert ticket fees. Ticketmaster’s fee backlash can teach employers about PBMs.