For years, "affordability" in pharmacy benefit management has meant one thing: lower unit costs. But ask any employer who has opened a renewal and found a number they didn’t expect, and you’ll hear a different definition. Affordability isn’t just about how much something costs. It’s about knowing what it will cost before it happens.
That shift in expectation reflects a broader change already underway. For years, pharmacy benefits have relied on a model where a meaningful share of pharmaceutical value showed up months after a prescription was filled, reconciled later through rebates—an approach that continues to serve many clients well today. But the market is evolving: rebates are declining, regulatory scrutiny is intensifying, and fiduciary expectations are rising. Clients and members alike are looking for more predictability and confidence in the true cost of their medications.
Why employers struggle with PBM transparency and pharmacy pricing
New research underscores the scale of the transparency challenge. According to a survey conducted by Penta Group on behalf of Evernorth Health Services, nine in ten employers say that a model ending rebates and giving savings directly to patients would improve the transparency of prescription drug pricing. That’s not a fringe concern—it sits at the center of the buying conversation.
Pricing built around unit cost alone doesn’t always account for volatility protection. The result: employers can still find it hard to know how a competitive sticker price will translate into actual spend over the course of a year. When a PBM’s compensation depends on rebates that arrive months after the prescription is filled, the true cost of pharmacy benefits remains opaque until well after the plan year is underway.
The same unpredictability reaches members. A routine prescription becomes a moment of anxiety at the pharmacy counter when the price at point of sale doesn’t match what a member expected. For employers and members alike, the gap between the promised price and the actual price erodes trust in the PBM relationship.
How Evernorth Signature delivers predictable pharmacy pricing
How can employers make pharmacy costs more predictable?
The question shifted from “how low can the price go?” to “how do we give clients a price they can actually plan around?” Evernorth Signature Pharmacy Benefit Services answers that question with a transparent, rebate-free, fee-based model built on three principles.
What changed with the fee structure
Rather than layering in inferred costs or indirect margin, the model uses a straightforward administrative fee, so clients see exactly what they pay for and why. The fee is clearly stated in plan contracts and is not based on the list price of the drug, making it easily auditable.
How members benefit at the pharmacy counter
That same principle carries through to the member experience. Instead of rebates months later, pharmaceutical discounts are applied immediately at the point of sale when the claim is adjudicated. The goal is pricing predictability that lets members go to the counter with confidence, knowing the price they see is genuinely the lowest net cost available to them.
Why accountability is built in
Critically, the model backs its pricing with real accountability: it puts fees tied to the PMPM guarantee at risk. If performance targets go unmet, that risk becomes real and dollar-for-dollar, creating a structural incentive to deliver the outcomes the pricing promises and not just the pricing itself.
Why this matters more than ever
The regulatory landscape is catching up to what employers have been demanding. The Consolidated Appropriations Act of 2026 requires PBMs to provide detailed semiannual reports to large employers on drug spending, rebates, fees, and spread pricing arrangements. Separately, the Department of Labor’s proposed PBM fee disclosure rule would require PBMs to disclose direct and indirect compensation to fiduciaries of self-insured group health plans. Together, these developments make PBM transparency not just a market preference but a compliance expectation.
None of this works as a one-off fix. It requires connecting pricing, performance, and member experience as one system rather than three separate levers. This approach shifts the focus away from complexity and toward clarity, accountability, and exceptional care, which ultimately fosters improved outcomes.
For employers, that means a cost structure they can plan around, not just a rate they compete on at renewal. For members, it means fewer surprises at the counter and more confidence that what they pay reflects real value. For the market as a whole, it signals a shift in what “affordable” should mean going forward: not simply lower cost—but more predictable.
The new standard for predictable prescription drug costs
Affordability that can’t be predicted isn’t really affordability. It’s a moving target dressed up as savings. As prescription drug costs continue to draw scrutiny from employers, consultants, and members alike, the PBMs that win the conversation won’t be the ones with the lowest number on a slide. They’ll be the ones whose clients can say, with confidence, “I know what this is going to cost, and I know why.”
That’s the standard employers can now expect. See how the Evernorth Signature model helps employers plan with greater confidence.
Evernorth SignatureSM pharmacy benefit services is a transparent, performance-aligned pharmacy benefits model that helps plan sponsors manage pharmacy spend with greater confidence through predictable pricing, simplified administration, and member-first affordability.
