For more than 30 years, the pharmacy benefits industry has tried to make prescription drug costs transparent. We’ve passed legislation, issued executive orders, and built endless dashboards — yet drug spend continues to rise, employers remain frustrated, and pharmacy benefit managers (PBMs) still operate inside a black box.
The problem isn’t a lack of technology or regulation. It’s how both have been applied. We’ve built systems to track old problems instead of preventing new ones — tools designed to explain yesterday’s spend rather than expose today’s opportunities.
The Black Box Was Built to Stay Closed
Pharmacy benefits are locked inside static contracts and annual reviews. Rebate layers are so dense that even well-intentioned employers and brokers struggle to follow the money. Meanwhile, three companies manage nearly 80 percent of all prescription claims in the U.S. — and they also own the pharmacies, the insurance plans, and the claims processing systems.
When you control every side of the table, transparency isn’t just difficult — it’s dangerous to your margins.
Legislative reform has tried to address this imbalance. The PBM Transparency Act is a meaningful step forward, as are various state-level measures. But regulation alone doesn’t dismantle black boxes — it often just makes the walls more complex. Real change requires something the current system isn’t built to handle: live, unfiltered data that’s actionable at the moment a claim is made.
In our latest white paper on pharmacy benefit transparency, we explore how regulatory pressure and outdated PBM frameworks have collided to create today’s cost crisis.
Other Industries Tore Down Their Walls Long Ago
We’ve seen what happens when industries embrace real-time data. Uber didn’t wait for new laws to make taxis fairer. Stripe didn’t need new oversight to make payments faster. Amazon didn’t wait for reform to fix logistics inefficiencies.
They built dynamic systems that removed guesswork, exposed inefficiencies, and optimized every interaction in milliseconds.
Healthcare, by contrast, remains the last analog holdout in a digital world. Pharmacy benefits are still lugging a heavy couch up the stairwell, yelling “pivot” every few years — instead of tearing down the walls and putting in a freight elevator.
The Data Is Already There — It’s Just Not Being Used
The truth is, the data to lower pharmacy costs already exists. Every single claim has a lowest possible net price somewhere in the market. The issue isn’t data scarcity — it’s that the industry lacks the tools or the will to surface that number and act on it in real time.
PBMs continue to negotiate annual contracts based on outdated data, then retroactively claw back money months later through direct and indirect remuneration (DIR) fees. Employers often see their true costs long after the opportunity to capture savings has passed. That must change.
From Dashboards to Decisions
The future of pharmacy benefit management isn’t more dashboards. It’s systems that predict, simulate, and act. Modern platforms should be able to map PBM decision patterns, forecast benefit changes before they occur, and automatically route each claim to the lowest-cost channel — all without waiting for a contract renewal.
Employers deserve the ability to see, in real time, whether their PBM is actually delivering the lowest net cost — not months later through an audit, but at the exact moment the claim is processed.
Let the Data Do Its Job
This evolution isn’t about replacing people with machines. It’s about letting technology do what it does best, so people can focus on strategy, relationships, and results.
When real-time data flows freely, brokers negotiate smarter. Employers adapt faster. And PBMs can finally prove their value instead of hiding behind complexity.
The walls around the black box aren’t made of steel — they’re made of outdated processes and bad habits. The moment we decide to trust real-time data and let it lead, those walls fall fast.
It’s time.
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