Retail pharmacies are closing. Drug prices are soaring. And Pharmacy Benefit Managers (PBMs)—the middlemen controlling drug access and pricing—are finally facing congressional scrutiny.

But the real question employers should be asking is: What is this costing us—and why aren’t we doing more about it?

The Cracks in the Pharmacy System

In the last few years, over 2,000 U.S. pharmacies have shut down, driven by inflation, shrinking margins, staffing shortages, and—most significantly—unsustainable reimbursement models. Independent pharmacies, long relied upon by local communities and employees alike, are being squeezed out as PBMs slash reimbursements, particularly on high-cost medications like GLP-1s (used for diabetes and weight loss).

A recent survey found that 50% of independent pharmacies have stopped dispensing GLP-1 drugs altogetherbecause they lose money every time they fill one. For employers, this means less access for employees, delayed treatment, and higher downstream costs when chronic conditions aren’t managed properly.

How It Hurts Employers—Especially the Self-Insured

For self-insured employers, the pharmacy crisis isn’t just a healthcare issue—it’s a financial crisis hiding in plain sight.

According to the National Alliance of Healthcare Purchaser Coalitions, pharmacy benefits now make up 30–35% of total healthcare spend for employers, up from just 20% five years ago. GLP-1 medications alone are expected to exceed $100 billion in global sales by 2030, and they’re already costing plans thousands per member, per year.

Yet, many employers have no idea what they’re actually paying due to PBM contract opacity, spread pricing, and clawbacks. This is compounded by the complex, time-consuming prior authorization process, which delays care and burdens HR teams with administrative overhead.

A Broken System—Finally Under a Microscope

PBMs like CVS Caremark and OptumRx are finally facing pressure. Congressional hearings have brought attention to their non-transparent pricing structures, and both companies have announced plans to adjust reimbursement models and ease access—such as Optum’s initiative to eliminate 25% of prior authorizations for 80 common drugs.

Still, these changes remain limited in scope and impact. Real change requires employers to act now—not wait for regulators.

Why Independent Advisors Are the Missing Link

The employers seeing real savings are the ones who work with independent consultants to:

• Review and renegotiate PBM contracts to eliminate spread pricing and improve transparency
• Implement alternative pharmacy solutions such as Direct Primary Care or independent dispensing channels
• Enroll eligible employees in Patient Assistance Programs, like those offered through RX Solutions and Impact Rx, which use industry experts and clinical pharmacists to lower high-cost prescriptions
• Automate and optimize prior authorizations using AI-driven tools to reduce delays and improve outcomes

These aren’t fringe strategies. They’re proven.

In one example, an employer working with an independent consultant cut their per-member-per-month pharmacy cost by over 22% in 12 months through contract changes, transparency clauses, and support services for employees.

Another reduced employee cost share for GLP-1s from $600/month to under $75 by combining cost-containment strategies with a DPS (Direct Patient Support) program.

The Big Question: Why Aren’t You Doing This?

If you’re self-insured, ask yourself:

• When was the last time you independently audited your PBM contract?
• Do you know how much spread pricing is inflating your drug spend?
• Are your employees skipping medications or care because of delays or cost?
• Why wait for legislation to fix a system you can change right now with the right partner?

Final Thought: It’s Time to Take Control

The pharmacy reimbursement crisis is more than a retail issue—it’s a strategic, financial, and cultural issue for your business. Employee productivity, retention, and wellbeing are directly impacted by access to affordable medication.

The employers who win in this environment will be the ones who take bold action now—through transparency, advocacy, and strategic partnerships.

Independent consultants can help you see what the brokers and big PBMs won’t show you.

Written by: Pat Isaac, CEO of Capital Services, Inc.

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