By Stacy Mays
This may be the most important change in healthcare in 20 years.
Do you know one of the biggest reasons drug prices are so high in the U.S.?
💊 PBMs.
Drug manufacturers mark up prices for consumers by 40–80% so they can pay rebates to PBMs.
Those rebates determine whether a drug gets on a formulary.
Sometimes, plan sponsors see part or all of that rebate.
Consumers never do.
Now that’s changing.
In response to commitments made to the White House earlier this year, several drug companies are going direct-to-consumer — bypassing PBMs altogether.
If you pay cash, the total cost is often less than the PBM’s net price after rebates.
➡️ Example:
• Wegovy via PBM: ~$1,000/month
• Rebate: $450
• Cash price: $499
Same story for Cosentyx and others — at less than 50% of the PBM price.
(Yes, Wegovy is still $200 in Europe… but one step at a time.)
Forward-thinking employers can now drop PBM coverage for certain drugs and support employees by funding cash cards for direct purchase — lowering total cost and improving access.
These changes are happening fast.
And they could completely restructure how drugs are priced and paid for in America.
What’s your reaction?
Revolutionary step toward transparency — or chaos in the making?
