From prior authorizations (PAs) and formulary restrictions to pharmacy steerage and increased costs for employees and patients, pharmacy leaders often find themselves navigating the fallout of opaque benefits design.
With cost pressures high and an increasingly complex pharmaceutical landscape, pharmacy leaders have a vital role to play in advocating for transparent, clinically sound benefits strategies for their employees.
What hospital and health system pharmacy leaders are up against
Large PBMs may be motivated to make profit-driven decisions, but they’re rarely optimized for patient outcomes or operational efficiency.
Even when decisions are made with good intent, pharmacy leaders are left guessing:
- Was this the best option for the patient and plan, or the most profitable for the PBM?
- Is the in-house pharmacy reimbursed fairly for the medications being dispensed, and do pharmacy leaders have clear visibility to the financials?
- Are in-house pharmacies given the same contract terms as PBM-owned or other preferred pharmacies?
What transparency means in pharmacy operations
Transparency isn’t just a contract term – it’s a clinical and operational necessity. Pharmacy leaders need insight into:
- Drug-level reimbursement and pricing, not aggregate performance summaries
- Formulary decisions based on clinical value, not manufacturer incentives
- Contract clarity around claims, payments, and in-house pharmacy utilization
- Operational alignment between benefits design and in-house pharmacy goals
When leaders can see what’s driving trends and trust that decisions are clinically justified, they can focus more on delivering effective, sustainable care for patients.
How pharmacy leaders can advocate for change
While pharmacy leaders may not be in the driver’s seat on benefits design, their voice carries weight. By advocating for transparency and clinically aligned partners in HR, they can help shape plans that better serve patients and ease their teams’ operational load.
At RxBenefits, we believe transparency should empower clinical care. Our approach, backed by a team of 340B and Apexus-certified experts, combines human-led clinical management and conflict-free contract structures that support in-house pharmacy performance. We operate as an extension of your team, not an added barrier.
CALLOUT: Learn how RxBenefits helped a 13K member health system save $1.5M in one year by capturing more volume through its in-house pharmacy.
A call to action for pharmacy leaders
Transparency in benefits design isn’t just about numbers – it’s about maintaining clinical logic in the way a hospital or health system pharmacy works. And pharmacy leaders, more than anyone, are positioned to recognize when the system isn’t working and speak up.
Advocate for what your employees and your pharmacy deserve: a clear, clinically aligned benefits strategy that reduces friction, supports in-house dispensing, and keeps decisions grounded in patient care.
RxBenefits partners with more than 200 hospitals and health systems nationwide to help bring transparency to every corner of benefits strategy, so you can focus on what matters most: delivering the best possible care.
To learn more about how RxBenefits supports hospitals and health systems with clinically aligned, pharmacy-first strategies, visit our hospital solutions page.
