“Transparency” has become one of the most overused words in pharmacy benefits.
Nearly every PBM claims to be transparent. Marketing materials promise visibility and pass-through pricing. But when you really dig into the details, many PBMs still benefit from hidden revenue streams, vague contract language, and very little ability to validate how they’re actually getting paid.
True transparency isn’t a buzzword, it’s a set of measurable practices. If your PBM is truly transparent, you shouldn’t have to take their word for it. You should be able to verify it.
Here are six things every employer should expect from a transparent PBM relationship.
1. Your Data Should Belong to You
Your pharmacy data is a valuable asset. It tells the story of your utilization trends, high-cost drivers, clinical opportunities, and future savings potential.
Unfortunately, many plans discover that accessing their own data isn’t always easy, especially if they change PBMs.
A transparent PBM should recognize that your data belongs to you. You should have ongoing access to detailed reporting and retain ownership of your historical data, even if you move to another vendor. Without that access, it becomes much harder to evaluate performance or make informed decisions about your pharmacy strategy.
2. You Should Have Meaningful Audit Rights
Trust is important, but verification matters.
Many PBM contracts advertise pass-through pricing while making it difficult, or nearly impossible, to validate the actual economics through an independent audit.
A transparent PBM should provide clear audit rights that allow you to confirm contract compliance, manufacturer revenue pass-through, and financial accuracy. Whether you choose to perform an audit or not, the ability to do so creates accountability and confidence that the contract is performing as intended.
3. Contract Language Should Protect the Plan, Not the PBM
The fine print matters, and many PBM agreements contain broad or loosely defined terms that leave room for interpretation long after the contract is signed. Definitions surrounding Average Wholesale Price (AWP), generic drugs, limited distribution drugs, specialty classifications, and rebate eligibility can significantly impact plan costs if they are ambiguous.
A transparent contract should clearly define these terms and apply them consistently throughout the agreement. The fewer gray areas, the fewer opportunities for manipulation.
4. You Should Receive 100% of Manufacturer Compensation
Manufacturer revenue comes in many forms, and employers deserve visibility into every dollar.
A truly transparent PBM should pass through 100% of all manufacturer compensation associated with your plan, not just traditional rebates, but all eligible revenue sources tied to your utilization.
There should be no hidden retention, no undisclosed intermediaries, and no uncertainty about where those dollars are going. Your plan should receive the full financial benefit.
5. Your PBM Should Continuously Evaluate the Market
The pharmacy landscape changes constantly. New biosimilars launch. Manufacturers adjust pricing strategies. New indications and competitors enter the market. Opportunities that didn’t exist a year ago may create significant savings today.
A transparent PBM shouldn’t wait for you to ask questions. They should proactively review the market and evaluate emerging opportunities through regular market checks. Ongoing checks and re-checks should be part of the relationship.
6. Pricing Should Be As Simple As Possible and Incentives Should Be Aligned
The easiest way to hide costs is through complexity.
When compensation varies based on utilization, rebates, or owned pharmacies, incentives can become misaligned with the plan’s best interests.
Transparent PBMs should make it clear how they are being paid. Straightforward cost structures paired with meaningful performance guarantees, create accountability while ensuring that the PBM succeeds by delivering value, not by increasing drug spend.
Transparency Should Be More Than a Promise
Transparency isn’t about providing more reports or using industry buzzwords. It’s about creating a relationship where the plan understands how decisions are made, where every dollar flows, and how their pharmacy benefit is performing.
At SlateRx, transparency is built into the way we operate.
When we say transparency, here’s what we mean:
- You’ll have access to your data and the insights it provides.
- You’ll have audit rights and visibility into the results of our reviews.
- You’ll see exactly how we are compensated.
- You’ll receive 100% pass-through of all manufacturer compensation.
- You’ll benefit from annual market checks designed to identify new savings opportunities as the industry evolves.
Transparency should be something you can see, measure, and verify. The more you can see behind the curtain, the more confident you can be that your PBM is working for your plan, and not for its own benefit.
