Employers still rely too heavily on discounts and rebates to shortlist Pharmacy Benefit Managers (PBMs), according to US-Rx Care, even though those metrics have not controlled pharmacy trend over decades of time and may prevent a full fiduciary comparison before the real evaluation begins.
TAMARAC, Fla., July 20, 2026 /PRNewswire/ -- Employers have spent decades chasing bigger discounts and richer rebates in PBM bids. Yet pharmacy costs keep rising. According to US-Rx Care, many employers are still starting with the wrong question. The current PBM buying process often rewards spreadsheet optics over actual cost control, pushing employers to compare rebate guarantees and discount promises before they ever ask whether a PBM can lower net cost, reduce pharmacy spend, or operate without conflicts of interest.
"Employers are missing the bigger picture," said Renzo Luzzatti, CEO of US-Rx Care. "If you focus on discounts and rebates, the wrong PBM can end up looking like the winner on paper." That matters more now because employer oversight of PBM relationships is becoming harder to approach simply as a routine administrative exercise.
The U.S. Department of Labor estimates that PBMs provide prescription drug benefits to roughly 90 million Americans through employer-sponsored self-insured health plans. Many employers believe they have ran a competitive PBM search in the past, when the process may have been tilted from the start.
The Problem with the Wrong Evaluation CriteriaAccording to Luzzatti, employers and consultants have been conditioned to use discounts and rebates as the main shortlisting criteria in PBM request-for-proposal (RFP) processes. As a result, PBMs have learned to optimize for those two metrics. The problem is that neither have proven to be a true cost-savings strategy on its own. Although attractive in a bid, it doesn't control which drugs are being used or whether those therapies are clinically appropriate.
"Discounts matter, but once you strip away the industry's pricing optics, most PBMs are offering numbers in the same range," Luzzatti said. "An 80% discount means little if the plan is buying the wrong drug or the price is inflated." Traditional PBM formularies and prior authorization rules can deepen that problem driving utilization toward options that generate more revenue for the PBM instead of the lowest net cost for the plan and its members.
A playbook published by The National Alliance of Healthcare Purchaser Coalitions also warns that PBM selection processes can be distorted by referral fees, compensation arrangements, and unclear contract terms, while Purchaser Business Group on Health has published purchasing standards aimed at helping plan sponsors move beyond opaque economics and misaligned incentives.
