Pharmacy System Rewards the Wrong Results. It is Working as Designed

Rebates, specialty pharmacy revenue, and standard performance metrics can make pharmacy benefit management appear successful even as employer costs rise, patients struggle with access, and financial incentives remain misaligned.

Pharmacy costs are consuming a growing share of employer healthcare budgets, but high drug prices and opaque contracts do not explain the entire problem. Employers continue to face spending above expectations despite rebate guarantees, contractual discounts, and more reporting because greater visibility does not necessarily change what the system rewards.