Reclaiming Pharmacy Benefits: Why Employers Are Rethinking the Status Quo

H Catausan
Jul 8, 2025
4 min read

Updated: Jul 9, 2025

If it feels like you’re spending more on pharmacy benefits but getting less for your people, you’re not alone.

For years, Pharmacy Benefit Managers (PBMs) have operated in the shadows—their contracts riddled with fine print, their pricing structures opaque, and their incentives often misaligned with the very employers they’re supposed to serve. Employers were promised savings, yet pharmacy costs continue to rise faster than inflation.

It’s time for a change. And many employers are realizing they don’t need to wait for regulation to make it happen—they just need the right questions, tools, and partners.

The Problem Is Systemic — But It's Also Fixable

Here’s what’s becoming increasingly clear to CFOs, HR leaders, and benefits consultants alike:

PBMs make money when you spend more, not less
Rebates distort value—they prioritize volume and brand-name prescriptions over true cost-efficiency and clinical efficacy
Transparency without auditability is meaningless—if you can’t see the numbers behind the claims, you can’t manage the spend
Self-funded employers carry all the risk—yet often have the least insight into what they’re actually buying

This combination of complexity and misalignment has created a system that’s difficult to navigate—and easy to exploit.

But it doesn’t have to be this way.

A Simpler Way to Take Back Control

At OVD Insurance, we believe employers should own their data, understand their contracts, and be empowered to make decisions based on facts, not fear.

We’ve developed a simple but powerful approach to help employers uncover waste and reclaim control—starting with a 4-phase roadmap to evaluating your pharmacy benefit program:

Audit—Begin by gathering and reviewing your PBM contract, claims reports, and fee schedules. Look for clauses that restrict audit rights, enable spread pricing, or define rebates in vague or proprietary terms.
Clarify—Decode the fine print. Understand how your PBM earns revenue, and how that may conflict with your plan goals. Who controls the formulary? Who keeps the rebates? Who sets MAC pricing?
Align—Based on what you learn, seek out transparent models. That may include pass-through PBMs, fixed-fee administrators, or pharmacy carve-outs. The right solution depends on your goals — cost savings, clinical impact, member experience — but the key is alignment.
Act—Implement with structure. Set expectations around audit rights, performance guarantees, and clinical reporting. Build accountability into your ongoing benefits governance.

This isn’t about switching vendors overnight. It’s about gaining leverage, clarity, and confidence — so you can protect both your employees and your budget.

Upcoming Event: “A Tough Pill to Swallow”

To help employers better understand their pharmacy options, we’re hosting a focused conversation on July 22, 2025:

A Tough Pill to Swallow: Understanding Pharmacy Coverage Options

🗓️ Date: July 22, 2025

🕒 Time: 8:30 AM – 11:00 AM (doors open at 8:00)

📍 Location: OVD Insurance, 2780 44th St SW, Wyoming, MI 49519

💻 Virtual option available

You’ll hear directly from seasoned experts and innovative solution providers who are helping employers:

Decode the rebate game
Structure truly transparent PBM relationships
Improve member experience and outcomes
Audit their plans with confidence

It’s not a sales pitch—it’s a working session for finance, HR, and operational leaders who want to make smarter pharmacy decisions in 2025 and beyond.

Get the Reform Toolkit

In advance of the event, we’re offering a downloadable guide: The OVD Pharmacy Benefit Reform Toolkit—created to help employers self-evaluate their current pharmacy arrangement and prepare for more informed discussions.

What’s inside:

7 questions to ask your PBM before renewal
Red-flag contract language that may be costing you
How to evaluate whether your PBM is aligned with your goals
Preview of what we’ll cover in the July 22nd event

➡️ Download the toolkit here: [Click Here]

Real Questions Employers Are Asking Right Now

Employers across industries—from manufacturing and logistics to education and healthcare—are waking up to the same pattern. Here are just a few of the questions we’re hearing from CFOs and HR teams:

“Can we audit the actual acquisition cost of every drug dispensed?”
“Who really keeps our rebates—and how much of it do we actually see?”
“If our PBM is also our carrier, how do we know they’re not just paying themselves?”
“How do we benchmark what we’re paying versus what we should be paying?”
“What happens if we do nothing?”

The good news? You’re not stuck. The answers—and the tools—already exist.

Next Steps

Download the Reform Toolkit—start with what you have. Use the checklist to identify what questions need to be asked and where your plan may have vulnerabilities. - Click Here
Register for the EB Summit—This is the single best place to get up to speed on where pharmacy benefits are headed and what employers can do about it.

🔗 [Register Here: https://bit.ly/OVD_EBJuly25Summit]

Talk to your CFO or HR partner – These are strategic conversations, and they require finance and people leadership alignment.
Connect with OVD—our team is here to help you navigate the path forward, whether that’s a quick contract review, benchmarking support, or a full audit.

Final Thoughts

Pharmacy doesn’t have to be a black box. And you don’t need a PhD in pharmaceutical supply chain economics to understand where your dollars are going.

You just need a guide, a good set of questions, and a willingness to challenge the status quo.

Join us July 22nd—in person or virtually—as we peel back the layers and help employers make smarter, more sustainable pharmacy decisions.

Because every dollar matters. And every dose should deliver.

— Herb