Understanding PBMs

Pharmacy Benefit Managers (PBMs) influence a significant portion of how employers handle prescription drug costs, yet many leaders still don’t fully understand how they operate behind the scenes. In this candid conversation, Amanda Brummitt sits down with longtime collaborators and friendly competitors Bret Brummitt and Alex Dampf to explore what PBMs are, how they make money, and the conflicts of interest that can arise. The discussion covers spread pricing, rebates, contract language, and the growing interest in transparent PBM models. It’s an honest look at what’s working, what’s not, and what employers should be paying close attention to. Alex and Bret also explain how to assess the value of a PBM, what to look for in contract terms, and why some cost-saving strategies may not deliver real value. This episode is filled with clear examples, practical advice, and a few dad joke laughs along the way. Topics include: The true role of PBMs in employer health plans Conflicts of interest in integrated PBM models Spread pricing and rebates explained The promise and limitations of transparent and pass-through PBMs Key contract terms and questions employers should be asking