But for all that PBMs do to reduce costs and improve the quality of pharmacy benefits, it is important to understand that employers, unions and government programs are in the driver’s seat. Ultimately, these payers design benefits, create formularies, decide on the levels of transparency as it pertains to rebates and discounts PBMs negotiate with drug manufacturers, and the amount of rebate dollars they choose to retain. After all, it’s those providing coverage that best understand the unique set of enrollees as well as its own financial picture.

I know first-hand how the contracting process involves a very rigorous process entailing financial value as well as operational acumen, levels of transparency, audit rights, the ability to provide pharmacy choice and patient satisfaction, capabilities to reduce fraud, waste, and abuse, and improve patient care through mail and specialty pharmacies.

PBM clients use a “request for proposal” (RFP) process, and often hire expert benefit consultant firms to provide assistance. These benefit consulting companies are nationally prominent entities that utilize high tech resources to evaluate PBM services for clients. This RFP process ensures that each PBM client receives services it uniquely needs and desires.

The bottom line is that the system is working for employers. A multitude of PBMs are lining up to provide these types of services to clients. In my experience, if the client wants something, it is provided – if not a PBM competitor will step in to provide it, it’s that simple.