Pharmacy has crossed 24% of total healthcare costs. Here is what you control

Pharmacy spend is growing 10% to 12% a year, faster than medical costs. In a fully insured arrangement, you pay all of it and see almost none of it. The carrier holds your claims data, keeps the manufacturer rebates and controls the PBM contract. This guide maps exactly what you can act on now and what changes when your funding structure does.

• A clear view of what you actually own. The guide separates three lanes: what you can act on today within a fully insured plan, what the carrier controls that you do not, and what changes when your funding structure changes.
• Specific dollar context for the decisions you are already making. Specialty medications now account for more than half of your pharmacy spend. GLP-1 medications for obesity carry a gross annual cost of $16,000 to $17,000 per covered employee. The guide shows you what owning your claims data means for decisions at that cost level.
• A plain-language explanation of where the rebates go. Your carrier retains the pharmaceutical rebates generated by your employees' prescriptions. The guide explains how that creates a structural conflict of interest in formulary design and what a PBM contract looks like when you hold it directly.
• A realistic account of what self-funding asks in return. Ownership of pharmacy data and PBM contract terms comes with month-to-month claims variability and increased fiduciary responsibility. The guide addresses both directly so you can size the trade before making it.

If you want to see how pharmacy costs sit within your specific funding structure, the Funding Strategy Assessment is the next step, and you can request it directly from the email you just received.