The TruthRx Difference

The fine print is the whole point

Most PBM contracts are written so the real cost is hard to find. Ours is written so it isn't.

The problem

Legacy PBMs profit from what you can't see

Three patterns show up again and again in traditional PBM contracts:

Spread pricing. The PBM pays the pharmacy one amount and bills the plan a higher, undisclosed amount — pocketing the difference.
Rebate retention. Manufacturer rebates get kept, offset against fees, or paid out as "credits" with compliance strings attached.
Steering & limited audits. Members get pushed toward PBM-owned pharmacies, and the plan's right to verify any of it is restricted.

These practices are well documented — see the FTC's 2024 report on PBM practices.

TruthRx is built around one principle

Full transparency. We pass through 100% of manufacturer rebates, charge exactly what pharmacies charge us — no spread — and give you real-time, script-level claims data so you can see every dollar in and out.

Know what to watch for

Contract language that should raise a flag

Before you sign with anyone — us included — these are the lines worth asking about.

Vague or one-sided

"Pricing sources or methodologies may be modified at [PBM]'s discretion."
"Manufacturer rebates and fees may be retained by [PBM]."
"MAC pricing is confidential and proprietary."
"Formulary changes may occur without prior notice."

Specific and auditable

Pricing adjustments require mutual agreement and advance notice.
100% of manufacturer rebates, fees, and price concessions pass through to the plan sponsor.
Pricing detail is provided monthly and subject to audit.
Formulary changes require advance notice and a documented impact analysis.

General education, not legal advice — always have your own counsel or broker review any PBM agreement.

The guarantee trick most employers miss

It's the same trick as a coupon full of exclusions

A "20% off" coupon that excludes half the store isn't really 20% off. PBM "guarantees" work exactly the same way — once you see it, it's obvious.

The trick
20% OFF*

"Guaranteed Discount"

*Excludes single-source generics, vaccines, and anything reclassified as "specialty." Calculated off whichever price list works best. Subject to change without notice.

Real savings: next to nothing

No asterisk
20% OFF

What a real guarantee looks like

No exclusions. Independent, industry-standard drug classifications. Measured against your plan's actual claims.

Real savings: 20%, as advertised

Swap "the store" for "your drug spend" and it's the exact same problem — it just wears more technical names in a PBM contract:

Discount guarantees

No independent, universally-applied definition of what counts as "brand," "generic," or "specialty."
Certain generics quietly reclassified as brands — or vaccines excluded entirely — to help hit the number.
Guarantees calculated off whichever pricing benchmark (AWP, WAC, NADAC) makes the number look best.

Rebate guarantees

"Rebate equivalents" allowed to stand in for actual rebate dollars.
Guarantee measured against the PBM's entire book of business — not your plan's actual claims.
Prorated or partial payments counted as meeting the guarantee, and drugs reclassified after the fact.

TruthRx guarantees are tied to your plan's specific claims — not our book of business — use independent drug classifications, and are defined in writing with no unilateral reclassification. No asterisk.

What the model can do

Illustrative results from comparable transitions

Every plan is different, but employers moving to a full pass-through model like this one have seen results in this range:

Large employer transition

-28.8%

Member cost per script

-12.7%

Plan cost per script (before rebates)

-49.6%

Plan cost per member per month (PMPM)

Small employer transition

-10.8%

Member cost per script

-20.7%

Plan cost per script (before rebates)

-20%

Plan cost per member per month (PMPM)

Illustrative results from comparable employer transitions (one large group, one small group) to a full pass-through pharmacy benefit model, compared against the same coverage rules under their prior PBM — actual results vary by plan and are not guaranteed.

In writing, not just in spirit

What TruthRx commits to

100% Pass-Through

No formulary-compliance hoops to earn full rebates. No illusory "credits." Script-level detail, monthly.

What You See Is What You Get

Billed exactly what the pharmacy is paid — same classification for payment, billing, and reporting.

Contractual Audit Rights

Full access to contracts, rebate detail, and pharmacy payment data — every year, guaranteed in writing.

Bring us your current contract

We'll show you, line by line, what a transparent version looks like.

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