By Bill Rusteberg
We are seeing the beginning of the end unfolding before our very own eyes. We’ve seen it before with the advent of Reference Based Pricing followed by Cash Pay Centric Health Plans. Both strategies shitcanned value draining middlemen.
Now we are seeing the same phenomenon with prescription drugs. Removing value draining PBMs is becoming a necessity in order to ensure the financial survival of plan sponsors who can no longer afford PBM cost savings that don’t exist.
Direct to consumer Rx sales avoids high level commissions re-languaged as “rebates.” (“Re-languaged” is not a real word unless you see it). Commissions as high as 70% (Humira) go away.
Our goal for 2026 is to find a plan sponsor willing to fire their PBM and try something new. It will be a grand experiment, testing our theory of relativity (the state of being dependent for existence by relation to something else).
The first plan sponsor to place their PBM in the dungeon of no return will become paparazzi famous and an example for others to follow. To our knowledge no one has done this since 1981 when no one even considered using a PBM because they didn’t exist.
Who will be the first to start a movement for others to follow?
