RxBenefits on the ULA Network

Empower Your Fund: Carve-Out Pharmacy Benefits and PBM Transparency 

For fund administrators, balancing member care with fiscal responsibility is a key priority. Integrating pharmacy benefits into your overall healthcare plan may offer convenience, but this approach often obscures true drug costs and rebate distributions, leaving your fund at a disadvantage. It’s time to consider a more strategic approach. 

Carve-Out Pharmacy Benefits

Carving out pharmacy benefits offers significant advantages over a carve-in model. By separating pharmacy benefits from your core healthcare plan, you gain greater flexibility, enhanced cost visibility, and direct control over drug spending. This approach also empowers your fund to partner with a Pharmacy Benefits Manager (PBM) that meets your specific goals. 

Choosing the Right PBM

When choosing a PBM partner, it’s important to understand that not all PBMs offer true transparency. Many rely on opaque pricing and retain rebates instead of passing 100% through to your fund. We explain the principles of a truly transparent PBM—from no spread pricing to full data access—and detail how to identify a partner whose incentives are aligned. 

By choosing a carve-out pharmacy model and the right PBM, your fund can contain rising costs and secure quality member benefits for years to come.