Is your PBM fiduciary-aligned?

When selecting a pharmacy benefit manager (PBM), it’s critical to ensure it aligns with your team’s best interests. Fiduciary alignment means your PBM is committed to prioritizing your organization's best interests above its own. A fiduciary-aligned PBM eliminates conflicts of interest, provides full pricing transparency, and ensures that all financial benefits, such as rebates or discounts, are passed back to you and your team.

Here’s a helpful checklist to assess your PBM. If you answer "yes" to any of the questions below, your PBM may not be acting in your best interest.

Drug classification.

• Can your PBM change its definitions of specialty, brand, or generic drugs without notifying you?

• Does your PBM classify any generics as specialty drugs?

• Are there specialty drugs on your PBM’s list that could be accessed at standard retail pharmacies without special handling?

Formulary design and rebates.

• Does your PBM retain any portion of rebates or other payments from drug manufacturers instead of passing 100% back to your team?

• If both a brand-name and generic version of a drug are on the formulary, does your PBM favor the brand-name drug with higher rebates?

• Does your PBM avoid aligning formulary placement with the true safety, efficacy, and net cost of drugs?

Pharmacy ownership and network steerage.

• Does your PBM own any pharmacies (retail, specialty, or mail-order) that may present a conflict of interest?

• Does your PBM limit access to independent or chain pharmacies within its network?

• Are your employees directed or steered towards pharmacies owned by your PBM, regardless of pricing at other pharmacies?

Pricing transparency.

• Is your PBM’s pricing structure based on spread pricing, rather than transparent pass-through pricing?

• Would your PBM restrict independent audits of Rx claims or plan management by a third-party consultant or auditor?

Contracts and reporting.

• Was your PBM the only option presented without consideration of other models (e.g., pass-through, fiduciary-aligned, or specialty carve-outs)?

• Are there limitations on your ability to receive timely reports?

• Are there financial penalties if you choose not to renew your plan?

At Rightway, we deliver a fiduciary-aligned PBM model that mitigates risk, maximizes pharmacy savings, and drives every prescription to the lowest net cost. As the only PBM with pharmacy navigation, we guide members to the most cost-effective, high-quality therapies and channels. See why fiduciary alignment matters here.