PBM 101: How to Evaluate Your PBM

Is Your PBM Aligned with Your Goals?

Choosing a pharmacy benefit manager (PBM) isn’t just about managing prescription drug costs – it’s about ensuring your PBM operates in a way that aligns with your financial, operational and philosophical goals. A truly aligned PBM works toward the same objectives as you: lowering costs, improving member experiences and delivering better health outcomes. 

When incentives are aligned, everything – from formulary management and network contracting to contract terms and clinical programs – is designed to serve your needs, not the PBM’s. 

So how can you tell if your PBM is truly working in your best interest?

A well-structured PBM can help plan sponsors optimize drug spending over time, protect employee well-being and ensure seamless execution of their benefits plan. However, not all PBMs operate with the same priorities.  

Some emphasize transparency and cost savings for clients, while others maximize their own revenue through hidden fees, retained rebates and upsell strategies. If your PBM isn’t fully transparent about pricing structures, contract terms or revenue streams, it may not be as aligned with your goals as you think. 

Consider these key differences:

The Navitus Difference: A PBM That Puts Clients First 

At Navitus, we believe true goal alignment means putting clients first – not just in words, but in action. Unlike traditional PBMs that profit from hidden fees and rebate retention, we operate with 100% pass-through and financial transparency. That means we make decisions that align with your organization’s goals, regardless of the potential impact to spread, margins or rebate dollars. Our focus remains on reducing costs, controlling trend over time, improving health outcomes and delivering real value to plan sponsors, health plans and members. 

If your PBM isn’t fully transparent or aligned with your goals, it’s time to explore a better alternative

Contact [email protected] to learn how Navitus can be that solution.