Misaligned incentives, spread pricing, opaque rebates, and specialty distribution models perpetuate extensive customer mistrust in PBMs, and for good reason. The only way the industry will change is if new players are able to disrupt the market by providing alternatives — and competition — to traditional PBMs.

A CAQH analysis finds administrative spending increased Despite a drop in transaction volume during 2020.

At issue is a price transparency provision that requires giving patients detailed upfront cost estimates--including a diagnosis--before treatment.