Haven't heard of it Many employers simply haven't been exposed to alternative PBM models or the considerable value a carve-out can provide. This underscores the importance of knowledgeable benefits advisors who can educate stakeholders and quantify potential savings and clinical improvements.

Three critical questions before selecting a carve-out PBM

For HR and benefits leaders considering a carve-out strategy, these questions can help identify the right partner:

Who owns the PBM?
Ownership matters. PBMs backed by venture capital may prioritize rapid growth and investor returns over operational excellence and service quality. Benefits advisors and employers should look for organizations with stable, aligned ownership structures that support long-term investment in member care and service quality rather than short-term metrics.
Are clinical programs built internally or outsourced?
In-house solutions typically deliver superior service, tighter integration, and better alignment with your company's unique needs and workforce. External partnerships often introduce coordination gaps, slower response times, and a one-size-fits-all approach that doesn't fit your workforce.
How do members access personalized support?
First-rate PBMs provide direct access to pharmacists, proactive outreach for complex therapies and responsive service when members need help the most. It's a clear alternative to long call holds, phone trees, and disconnected systems.

Innovate and challenge the status quo

With PBM practices under the microscope and employers and benefits advisors alike demanding change, forward-thinking organizations are seizing the carve-out advantage to unlock transparency, cut costs and deliver better care. Leaders who act now will set the standard for the next decade of benefits strategy. Don't wait for the industry to change. Be the change.

Instant Insights /

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