Employers Push for Transparency From PBMs | PBMI 2025

Employers are calling for greater transparency and stronger partnerships with pharmacy benefit managers (PBMs) as they continue to face rising prescription drug costs and complicated benefit designs. Many similar to Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, feel they lack the tools to decide whether patients are receiving the right medications at the right price.

Van Caulil shared these concerns in a conversation with Managed Healthcare Executive ahead of her discussion at the Pharmacy Benefit Management Institute’s annual meeting in Orlando. She noted that employers often can't see the true costs of the drugs they purchase, which makes it difficult to evaluate PBM performance.

“They really don’t have that kind of information to be able to roll up their sleeves with a good partner PBM to say, 'how can we do better for the patient?' Because that’s what we’re all here for,” van Caulil said.

She shared that employers rarely see clear “price tags” on drugs but instead receive data in somewhat of a cluster, which makes it challenging to assess whether benefit designs and utilization management tools—such as prior authorization or step therapy—are helping patients or creating barriers.

The discussion also focused on Florida’s comprehensive PBM reform law, which was enacted in 2023. The law was designed to improve oversight and transparency by requiring broad monitoring of PBM practices.

Van Caulil praised the legislation but also highlighted concerns about its implementation.

Because the monitoring process is extensive and expensive, contractors hired by the state are billing PBMs for their time. She added that those costs are then passed down to employers, and the law does not place a cap on the expenses. For businesses operating in Florida, this could cause a significant and unpredictable financial burden.

Van Caulil added that a mass of state regulations creates challenges for employers with workers in multiple states. She suggested that a national PBM transparency law would provide a more consistent and effective solution.