Transparency is out. Actionable data is in. | PBMI 2026

The economics of pharmacy benefits are shifting, creating a time of disruption for payers and patients. Regulatory shifts such as the Inflation Reduction Act, rising cost pressures, and technology such as AI are creating an environment of disruption.

Data transparency is needed, but it’s not enough to successfully prepare for the future of pharmacy care, speakers said at the opening session of the annual meeting of the Pharmacy Benefit Management Institute. What’s needed is actionable data and real-time technology to better manage rising costs and provide patients access to needed medications, they said.

Overall, retail prescription drugs accounted for 8.8% of healthcare spending in 2025, according to Peterson-KFF Health System Tracker. But panelists said costs are rising sharply, and they expect specialty and medical-benefit drug spending to be another 10% to 15% of medical costs on top of pharmacy spend.

Regulatory and legislative pressures for transparency are impacting not just government health programs but also the commercial space as well. But Dana McCormick, RPh, vice president, Practice Innovation and Business Strategies, Academy of Managed Care Pharmacy (AMCP), cautioned that transparency does not equal value.

“I don’t want us to confuse increased transparency with increased value because that is not the case,” McCormick said. “You can have transparency all day long, but that does not necessarily increase the value of what you’re purchasing.”

She pointed out that policy decisions that are driving increasing transparency, requiring pass-through rebates and the delinking of fees could potentially end up increasing costs for employers.

Panelist Krista Siano, vice president, Business Transformation at PSG, said that employers and their PBMs need to have conversations around the strategy they want to employ and the data they will need for that strategy. “Transparency means being able to see every dollar the pharmacy benefit touches, from manufacturer to PBM to pharmacy to patient, because once you can see where that dollar is going, you can make decisions that can really impact the total net cost.”

Siano pointed out that there used to be a willingness to deprioritize transparency for the guarantee of lower costs. “Now the economics are shifting, and those guarantees aren’t materializing,” she said. “Transparency is an ingredient now for trust and values.”

But employers have to own their pharmacy benefits strategy before looking for a new PBM and have a real understanding of their employee population and what those employees are looking for, said Patty Starr, president and CEO of Health Action Council. “We're looking for employers to create a new level of accountability that goes across the ecosystem,” she said. “Employers have to bring pressure for more accountability to each of their partners.”

In the past, McCormick said employers have expressed concern about increasing pharmacy costs and that has sometimes led to bad decisions. “There are opportunities for disruption and applying point solutions, but point solutions are not all equal. Employers need to be thoughtful about not giving up quality and value in exchange for lowering costs.”

Speakers said that over the next five years employers will continue the unbundling of pharmacy services and applying technology, especially AI.

Technology can increase transparency, McCormick said. She provides the example of utilization management policies, which are set at the population level. “There's not a ton of capacity to really build policies and include the dynamics of the patient and the patient experience and the specific patient demographics. Technology could change the way a policy needs to be applied for patients to get access.”

Technology could also help to create policies that are more personalized to the patient needs, Starr said. “We really expect a personalized and simple experience for the member. But the experience also has to guide people to the right care,” she said. “As we get that patient to the right place, we know that the overall care journey is going to have better outcomes and therefore impact actually the whole healthcare system.”