Pharmacy benefits now make up as much as 25% of the average self-insured employer’s healthcare spend, yet most benefits leaders can’t fully explain where that money goes. Traditional PBM models rely on opaque rebates, narrow pharmacy networks, and layered admin fees that quietly shift costs onto employers and employees. This whitepaper from Transcarent explains why the PBM market is changing and what a pharmacy-led navigation model looks like in practice. Inside, you’ll learn: How rebate-heavy PBMs inflate spend, and the forces driving reform, including legislation, fiduciary lawsuits, biosimilars, and online pharmacies The key differences between traditional, pass-through, and pharmacy-led navigation models How to evaluate PBMs on net cost instead of rebates, including MAC vs. NADAC pricing and admin fee structures Real results: Transcarent cut its own Rx spend by 52% in Q1 2025, and a Fortune 100 analysis projects $16M in annual savings A ready-to-use evaluation checklist for your next RFP Whether you’re reviewing your current PBM or preparing for renewal, this guide gives you the questions and benchmarks you need to make a confident, defensible decision.
