Heading into 2027, benefits leaders are weighing hard questions as they plan renewals and look after their members. We heard many of them firsthand at Behind the Benefits, our first Customer Advisory Board event. Thank you to everyone who joined us and spoke so openly about what's working and what needs to change.

These conversations keep us on the same side of the table as employers, focused on reducing pharmacy benefit complexity and costs through radical transparency and technology. Below, SmithRx experts explore six questions benefits leaders raised at the event.

1. What Can I Actually See in My PBM Contract?

“Employers want to know whether their PBM is delivering on its guarantee, so they need visibility into what the PBM earned on each claim. Many PBM contracts rest on an aggregate rebate guarantee, a fixed amount per brand or specialty claim. Most PBMs pool manufacturer dollars and allocate them based on each employer's negotiation, so two employers with similar claims can receive different rebates. An auditor can hold the PBM to the guarantee but can't see its manufacturer contracts, so employers' claim-level rebates stay out of view.”

• Alan Pannier, Chief Strategy Officer, SmithRx

SmithRx passes through what it contracts with the manufacturer and shows claim-level rebate detail, so your team or your auditor can trace each rebate. Platform-based pricing means every SmithRx client pays the same price for the same drug at the same pharmacy on the same day.

In a request for proposal (RFP), ask how manufacturer dollars reach the plan, claim by claim. That standard sits at the center of our modern PBM model.

2. Is Now the Right Time to Switch PBMs?

“The right time depends on whether your PBM is delivering and what your contract lets you do if it isn't. Five years ago, a large employer didn't have a great alternative to its incumbent PBM. Today, we're seeing employers sign one-year extensions with their current PBM to avoid lock-in while they weigh alternatives and plan to go to market.”

• Ezra Josephson, Vice President of Commercial Strategy, SmithRx

Switching PBMs is a big decision, but staying put has risks too. Too many PBM contracts leave employers with less visibility than the PBM has, which puts the two on opposite sides of the table.

We think a PBM should align its offering to support employers and members first. That's why flexibility and transparency are core to SmithRx's offering, and why we stand behind our performance. If we don't deliver, you can make a clean exit, without withheld rebates or penalty fees.

You can also ease into a transition, since you don't have to move everyone at once. Some employers start with a carve-out, where part of their population or a category of drugs moves first. Others start with a direct-to-employer program, where a manufacturer offers lower prices directly to employers.

We can work with the pharmacies and partner programs you already use, with room to expand. Before you decide, check your current contract for what it allows on early exit and for adding new options.

3. How Do I Make a PBM Transition Go Smoothly for Members?

“Start before go-live: tell members what's changing, why, and where to get help, and use more than one channel. Make simple tasks, like checking coverage or switching to mail order, self-serve. Then have advocates ready for changes that need a person, like a new prescription or a different pharmacy.”

• Sheila Brown, Vice President of Member Services, SmithRx

SmithRx works with your team on member communications before go-live. After go-live, our Member Portal and Mobile App show coverage, prescriptions, and prior authorization information, plus Find My Meds cost estimates at nearby pharmacies. Members with qualified dependents can view their family's prescriptions in one place.

For moments that need human support, like moving to a different drug or pharmacy, our in-house Patient Advocates are available to help.

4. Can I Trust AI to Answer My Members' Coverage Questions?

“An artificial intelligence (AI) assistant is only as trustworthy as the data available to it, so it should answer from the member's plan instead of guessing from general information. Most member questions are basic, like whether a drug is covered or where a prior authorization stands. Each accurate answer depends on that member's plan or benefit design and real case information, so an assistant that can't see them will frustrate members.”

• Gaston Concilio, Senior Vice President of Engineering, SmithRx

AI in pharmacy benefits should do two jobs: give members accurate self-service answers, and help support teams find the right information faster. SmithRx's assistant answers from the plan we administer, using each member's own credentials, so it only sees that member's information. When a question needs a person, our in-house Patient Advocates take the next step with the member.

When you evaluate a PBM's AI, ask where its answers come from and how it works alongside the plan's human support.

5. How Do I Get Members to Act on Prescription Savings?

“Members act when the savings are clear and the switch is easy. When they're aware that an alternative costs them less and is clinically appropriate for them, members are motivated to make the move.”

• Sheila Brown, Vice President of Member Services, SmithRx

When new biosimilars became an option for our members, they offered a clinically appropriate alternative at a lower total cost for the plan. Still, a member doing well on their current drug had every reason to ask why they should change.

As a modern PBM aligned with you and your members, we work to remove friction from savings, including through education for members and providers. Most doctors don't see what a drug costs when they prescribe, but care whether their patients can afford therapy. Our team shared clinical data and cost differences with providers, and most were willing to support the switch.

With their doctor's support, members had an easier path to making the change. Your own communications help too. When you explain during open enrollment why lower-cost options keep the benefit sustainable, members have a clear reason to act.

6. Should We Continue Covering GLP-1s?

“The evidence on glucagon-like peptide-1 (GLP-1) medical-cost savings is still thin, so coverage comes down to how much risk you want to carry. Manufacturers are now offering lower prices directly to employers through weight management programs. Whatever you choose, decide up front what you'll measure, like who uses it, how long they stay on it, and what it costs.”

• Alan Pannier, Chief Strategy Officer, SmithRx

Benefits leaders at our event described a range of approaches. Some cover GLP-1s with guardrails, like step therapy, maintenance dosing, and coaching or dietitian support to help members keep weight off. Others exclude GLP-1s for weight loss, while some keep coverage for contractual reasons.

As employers look for ways to manage GLP-1 costs, new options are emerging. Manufacturers now offer lower prices directly to employers through weight management programs instead of PBMs, an approach called the direct-to-employer (DTE) model. SmithRx processes those claims as a subcontractor, so the drug stays on the pharmacy benefit.

Employers can also require members to fill GLP-1s through the DTE program. The test is the same for every option: can you see what you pay and why?

The clearest answers start with your own numbers. To see how your current pricing compares, request a pricing analysis.