In part one of this series, we explored why pharmacy benefit transparency has become a governance issue for HR leaders and why surface-level disclosure often fails to reveal how costs and incentives actually work. This installment focuses on where employers have more leverage than they realize—and how to apply it deliberately in the best interest of plan participants.
If employers hold the purse strings, why don’t they push harder for transparency and better terms?
Part of the answer is that pharmacy benefits have evolved into a highly specialized and increasingly complex ecosystem, shaped by pharmacy benefit managers (PBMs) whose roles span clinical decision-making, pricing strategy and vendor incentives. As prescription drug economics have grown more opaque and financially consequential, oversight has expanded well beyond traditional benefit administration.