The Pharmacy Spend Crisis: Everyone's Talking About It—But Few Are Actually Fixing It

Big Pharma. Middlemen. Skyrocketing drug costs.
You’ve seen the headlines. Everyone’s talking about the PBM problem.

Congress is investigating. Journalists are digging. And employers are left wondering:
Why does this system cost so much—and who’s really benefiting?

Here’s what we’ve learned after years in the trenches: The traditional pharmacy benefit model is broken by design. And the only way to fix it is to stop playing their game.

That’s why we bet big on MedOne, a Pass Through PBM that does business differently—and it’s been one of the smartest moves we’ve made.

What’s Broken—and Who’s Paying for It

The big three PBMs control nearly 80% of the market. They negotiate drug prices, decide what’s covered, and manage the pharmacy network—all while making billions. But here’s the catch:

• They profit off markups between what you pay and what the pharmacy gets.
• They pocket rebates from manufacturers, while keeping you in the dark.
• They steer usage toward drugs that maximize their margins, not your savings.

And this model is no secret anymore:

“The public has finally caught on to how these ‘middlemen’ inflate costs. PBMs were meant to manage costs, but too often they’ve made them worse.”
— Wall Street Journal, “The Truth About PBMs” (2023)

“Prescription drug prices in the U.S. are the highest in the world—and PBMs play a big role in why.”
— Kaiser Health News

“PBMs serve themselves. Their profits come from complexity, not clarity.”
— Senator Chuck Grassley, 2023 PBM Oversight Hearing

So yes—it’s definitely getting headlines. But while others are still talking, we’ve already moved.

How MedOne—and Our Model—Change the Game

We partner with MedOne because they don’t profit off confusion. They pass through the actual cost of drugs and charge a flat admin fee. No spread. No backroom rebates. No perverse incentives.

And it works:

📉 63% below benchmark on PMPM pharmacy spend in our private program.
That’s not hypothetical—it’s real, proven, and repeatable.

We get transparency. Our clients get predictability. And their employees get better access at a better price.

So while the rest of the industry keeps pointing fingers, we’ve already locked in a model that works.