Beyond Transparency: How Employers Can Force PBM Accountability

Renzo Luzzatti, CEO of US-Rx Care, argues that switching vendors is ineffective if the underlying financial incentives remain misaligned. While many PBMs promote pass-through models, they frequently avoid the binding contractual obligations that would legally tie their interests to those of the plan sponsor. Luzzatti emphasizes that transparency and fiduciary duty are distinct concepts; a vendor might share data while still prioritizing its own profit margins over clinical outcomes.

To bridge this gap, US-Rx Care advocates for a rigorous, contract-level evaluation using a 10-point scoring system. This framework assesses critical areas including rebate disclosure, audit rights, and data ownership. Employers are encouraged to scrutinize whether a contract mandates the PBM to act under the Employee Retirement Income Security Act (ERISA) standards. By requiring vendors to accept full fiduciary responsibility, plan sponsors can move past promotional rhetoric to secure verifiable, long-term control over their pharmacy spending and clinical decision-making.