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The Prescription for Accountability: Why Reporting Must Be Your Next PBM Requirement

Oct 20, 2025

In the world of benefits, transparency is more than just a buzzword, it’s essential to success. Employers need to demand true transparency from their pharmacy benefits manager (PBM) in order to ensure alignment, protect members’ interests, and to accurately measure and validate savings claims.

Just having transparency and data access is only one piece of the puzzle: how do you turn data into actionable insights for your plan? For example, if your PBM’s data claim your business is getting ‘great’ discounts yet your costs continue to rise… that's a red flag. Data is proof, and having full access and the tools to make it actionable is key to holding your PBM partner accountable.

In our most recent Full Disclosure episode, PBM Transparency Beyond the Buzzword: How Data Drives Savings, benefits experts broke down the essentials of PBM data access and reporting—and why they’re crucial to achieving peak performance and realizing meaningful savings for your plan. Keep reading to discover how you can hold your PBM accountable and determine true plan ROI through reporting, or watch the complete Full Disclosure episode here

Your North Star: Per-Member, Per-Month (PMPM)

Many legacy PBMs will throw a ton of reporting out around discounts and rebates—but these kinds of reports can be manipulated and often do not paint a full picture of the ROI of your benefits program. When it comes to accurately measuring your plan’s performance, the most critical metric to track is your Per-Member, Per-Month (PMPM) spend.

PMPM is a cost metric used in healthcare to represent the average monthly expense for each enrolled member in a health or pharmacy plan. It's calculated by dividing the total cost of services and/or drug spend by the number of members, then by the number of months. 

Per-member, per month spend is a transparent alternative to the confusing pricing games often used by legacy PBMs to obscure their true cost. You can easily track it, benchmark it against industry data, and use it to hold your PBM accountable for the actual net cost of your plan.

PMPM is your north star, but you still need more guiding lights to illuminate the opportunities and improvement points in your pharmacy benefits strategy: that’s where reporting comes in.

Key Reports to Demand from Your PBM

To ensure true transparency and accountability from your PBM, you should get comprehensive reporting, down to your claim-level data

Here are the essential reports you need to guide strategy and gauge success:

  • PMPM: See the breakdown of your total net PMPM to understand where your money is going (gross plan pay, administrative fees, cost containment savings, and rebates).

  • Rebates: Your reports should confirm whether your PBM is passing 100% of all rebates back to your plan and your members. Without this, you may not be aware of PBM withholding or how much they actually received from the manufacturer. Additionally, a truly modern PBM partner will give you the ability to do rebate forecasting. 

  • Claims: Detailed reporting on every claim's status and its associated cost is essential to seeing "how the sausage is made". You should be able to see plan pay, member copay, and any cost containment measures engaged.

  • Top Plan Pay Drivers: These reports highlight the therapeutic areas and specific drugs with the largest impact on your overall plan spend. This information allows you to make informed plan design decisions and strategically collaborate with your PBM on addressing trends and identifying untapped savings opportunities.

  • Savings: Realized savings reports should cover essential metrics like ROI, program-specific savings, and top drug savings to gauge plan success. If your PBM is actively searching for and executing savings initiatives, they will provide on-demand access to their status so you can effectively track and forecast your savings pipeline.

Turning Insights into Action

Transparency and data access are essentially useless if you can’t actively turn those insights into action points with your PBM. Countless reports aren’t what get your business savings: the steps, procedures, and strategies your PBM follows based on those reports are what capture those opportunities.

This level of accountability and action isn’t possible with every PBM, especially legacy players. Your saving potential is directly tied to which partner you choose. 

When evaluating a PBM partner, make sure they can:

  • Ensure Fiduciary Alignment: Get a clear separation of administrative fees and drug costs to determine your true pricing. Select a modern PBM that is built on the foundational principles of transparency, alignment, execution, consistency, and simplicity.

  • Proactively Manage Spend: Regularly review your top plan pay drivers. Use this data to strategize with your PBM on alternatives and how to address increased utilization trends.

  • Identify and Execute Savings: Investigate lower-cost alternatives like generics and biosimilars. Ensure your PBM has the right, action-oriented processes in place to capture these projected savings—and actively monitor claims to confirm successful member transitions to these alternatives.

With the right PBM partner by your side, you won’t have to beg for useful and clear reporting, it will be proactively given and broken down for your team to utilize. If you're struggling with incomplete data access or obfuscatory reporting from your PBM, or if you're seeing reports boast of incredible discounts while your actual costs still rise, consider those major warning signs. It might be time to search for a new, truly modern pharmacy benefits partner.

To get more expert insights on holding pharmacy benefits vendors accountable and measuring true savings, watch our complete webinar, PBM Transparency Beyond the Buzzword: How Data Drives Savings, or download the Pharmacy Benefits Reporting Glossary & Accountability Guide.

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SmithRx

SmithRx is the #1 Modern PBM, relentlessly focused on eliminating the conflicts and complexity of legacy pharmacy benefits. Built on radical transparency and fiduciary alignment, we empower employers to take control of their pharmacy spend and experience with our 100% pass-through model.

Download our PBM Reporting Glossary and Accountability Guide

Download our PBM Reporting Glossary and Accountability Guide

Download our PBM Reporting Glossary and Accountability Guide

Download our PBM Reporting Glossary and Accountability Guide

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SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.

© 2025 Smith Health, Inc
SmithRx Logo

SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.

© 2025 Smith Health, Inc
SmithRx Logo

SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.

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© 2025 Smith Health, Inc