A New PBM Contract Does Not Guarantee Better Results, SHARx Explains Why

As employers reevaluate their pharmacy benefit arrangements, SHARx warns that comparing rebates, discounts, and guarantees may create the appearance of competition without changing the system driving high costs and access problems.

ST. LOUIS, Aug. 4, 2026 /PRNewswire/ -- Employers are putting more pharmacy benefit manager (PBM) contracts back out to bid, but multiple proposals do not always represent meaningful improvement for the employer and its members. A 2025 National Alliance of Healthcare Purchaser Coalitions survey found that 61% of purchasers had changed PBMs in the previous year or were considering a change within one to three years. Use of PBMs identified as transparent rose from 12% to 31%, while reliance on the three largest PBMs fell from 72% to 61%.

Those shifts show that employers are looking for alternatives. They do not prove that every new arrangement changes the incentives, sourcing practices or revenue structures contributing to cost and access problems. "Changing the vendor does not solve the problem if every vendor is evaluated under the same old rules," said Paul Pruitt, Chief Growth Officer of SHARx, a procurement management solution for high-cost prescription drugs. "If the model is part of the problem, employers have to reconsider what they expect from the ground up."

Several Bids Can Still Produce One Choice

Traditional PBM requests for proposals (RFPs) commonly compare discounts from average wholesale price, rebate guarantees, administrative fees, and network access. Those measures can help employers compare contractual offers, but they do not establish what the plan will ultimately spend or whether members will be able to obtain prescribed medications without unnecessary friction.

A large discount can still produce a high final price when it is calculated from an inflated starting point. A strong rebate guarantee may also appear favorable while leaving other sources of revenue or ownership relationships outside the comparison.

Business Group on Health reports that pharmacy's share of employer health care spending rose from 21% in 2021 to 27% in 2023. The organization has also cautioned that conducting another RFP will not, by itself, reduce costs over the long term. Employers must evaluate vendor performance, measurable outcomes, contract transparency, and alignment with broader workforce goals.

"What matters is what the employer actually pays for the medications its people use," Pruitt said. "A proposal can deliver the promised discount and still result in plan overpayment."

Compare the Model, Not the Offer

Employers and brokers should examine how each bidder earns revenue, which affiliated organizations participate in the arrangement, who determines where members are allowed to fill specialty medication, and whether the vendor benefits when prescription volume or drug spending increases.

That review should extend beyond the PBM named in the proposal. Employers should understand the roles of affiliated specialty pharmacies, rebate aggregators, group purchasing organizations, subcontractors, and other commonly owned entities that may receive revenue from the arrangement.

Transparency should also be tested at two levels: what the vendor promises and what the employer can verify after implementation. "Anyone can make a claim in a proposal," Pruitt said. "The test is whether the employer can see the arrangement working in practice without waiting a year for an audit."

A genuinely different model should do more than disclose fees. It should show how the vendor's financial success is connected to lower net costs, more reliable access, and a better member experience rather than higher prescription volume or spending.

"Incentives are misaligned when one party has to lose for the other to win," Pruitt said. "A true partnership should succeed when the employer and its members achieve better results, and the way that happens should be easy to understand."

The RFP Must Test What Happens After Selection

Financial terms are only one part of a pharmacy arrangement. Employers and brokers should also compare implementation requirements, service commitments, member support, and the process employees must follow after the new contract begins.

Brokers and human resources teams often hesitate to change pharmacy partners because they are responsible for ensuring a smooth transition. That makes member experience a reason to improve the RFP, not a reason to preserve an underperforming structure.

Proposals should explain:

• How implementation problems will be prevented
• How members will receive assistance
• Which cost, access, and service outcomes the vendor will be accountable for delivering

Those questions move the RFP beyond promised terms and toward how the arrangement will perform once employees begin using it. "The strongest brokers are not negotiating the old model harder," Pruitt said. "They are helping employers determine what should work differently, which outcomes matter, and whether the options in front of them can actually produce those results. Otherwise, the RFP may change the vendor without changing the problem."

About SHARx
SHARx was founded to fight back against the broken system of overpriced prescription drugs. Industry pioneers Corey Durbin and Paul Pruitt built SHARx to put people before profits. With an innovative and ethical sourcing model, SHARx cuts through the waste with radical transparency, common-sense cost containment, and a member-first approach. No hidden markups. No games. Just the meds people need, delivered affordably, reliably, and with dignity. Learn more at: SHARXplan.com  

Sources:

• Business Group on Health. (2025, February 21). Taking action on pharmacy benefits: A Business Group on Health viewpoint. businessgrouphealth.org/Resources/POV-Taking-Action-on-Pharmacy-Benefits
• Business Group on Health. (2025, December 2). Trends to watch in 2026. businessgrouphealth.org/resources/trends-to-watch-in-2026
• National Alliance of Healthcare Purchaser Coalitions. (2025, September). Pulse of the purchaser: 2025 annual survey. pulseofthepurchaser.org/wp-content/uploads/2025/09/Pulse-of-the-Purchaser-2025-Annual-Survey.pdf

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SOURCE SHARx