Is Your PBM Charging $291 a Day for a $1.34 Pill?
Looking back at our February Pharmacy Benefits forum, we know it’s crucial to keep the momentum up. WHA is going deeper on PBM contracting and negotiation through 2027.
When a Washington public employer took the podium at our February forum, the picture of her pharmacy benefits managers costs had finally come into clear view. She told the room what its old PBM had charged for imatinib, the generic form of Gleevec: $291 per day supply, while a publicly posted cost-plus price list had the same drug at $1.34. Her team kept pulling the thread and found the plan had overpaid on generics by 39%, which came to $2.7 million on roughly $6 million of spend.
Nothing had stopped them from finding it earlier. No law changed and no vendor confessed; they simply learned where to look, and it took about eighteen months of webinars, free federal reports, and nights reading their own claims data. She said the right help would have cut that timeline considerably, and giving those eighteen months back to our members is what we are trying to do.
Your contract can be fully transparent and completely useless
Another panelist that joined us earlier this year put it best. Say he tells you there is money hidden in his house and whatever you find is yours to keep. Every word is true, but you are still standing in his hallway wondering whether to look behind the records or under the ice cube trays.
They thought it had a solid contract until its attorney found the discount guarantees applied in aggregate, a quiet way of saying the PBM could overperform on one drug, gouge on another, and still hit every number on the page. All of it disclosed, all of it legal, and all of it costing millions.
Nobody is coming to save you
A panelist who works federal PBM policy said that from our stage, and named why so many purchasers stay put: most employers badly underinvest in their benefits teams, so a plan covering ten thousand employees often runs on two or three staff. Stretched that thin, re-upping with the incumbent stops being a decision and becomes a default.
Congress passed the Consolidated Appropriations Act, 2026 in February, and its commercial market PBM provisions take effect January 1, 2029 for calendar year plans. When they do, plans with at least 100 employees get reports every six months, or quarterly on request, showing drug-level detail on what the plan paid the PBM, what the PBM paid the pharmacy, and every rebate and fee in between. Those reports will arrive whether or not anyone on your team can read them.
What comes next
Our Community Checkup 2026 shows why we keep returning to pharmacy spend. Washington employers absorbed an 8% increase in commercial health care costs in 2024, while prescription drug spending rose nearly 20% year over year. Across more than 4 million covered lives, pharmacy is the sharpest pressure point in the data, and no single employer negotiates its way out of that alone.
That is why WHA is going deeper on PBM contracting and negotiation through 2027, with targeted, interactive work rather than another webinar you half-watch. Every member is welcome, and we build the sessions for the people who sign the contracts.
The employer in this story learned none of it from her consultant, but from other purchasers further down the road who told her which conflicts of interest to look for. Putting our members in that room together is the point, because members who understand these contracts advocate harder for their employees and hold on to real money in their Rx spend. Nobody handed her that $2.7 million. She went and found it.