As specialty drug costs, GLP-1 spending and fiduciary scrutiny increase, many employers are asking whether their pharmacy benefit services can be reconfigured to reduce costs without creating new administrative and clinical risks.1
One strategy getting increased attention is to distribute pharmacy benefit services among multiple vendors.2
Instead of integrating all pharmacy care services together, the distributed pharmacy services strategy has employers contract separately for services, including claims administration, specialty pharmacy management, rebate contracting and clinical programs.3
The question plan sponsors need to ask themselves is: Which approach, integrated or distributed, is the best way for their plan to provide better access, adherence, affordability and health outcomes?
Organizations may select specialized vendors for specific pharmacy benefit services for various reasons. The idea is that this may drive increased competition to produce greater cost savings, enhanced contracting flexibility and improved rebate management.
Additionally, such distributed service arrangements may strengthen fiduciary oversight by giving employers more direct control over pharmacy services spending and service arrangements.
However, experts caution that distributing pharmacy services among multiple vendors can increase administrative complexity, requiring plan sponsors to coordinate vendors, integrate data, monitor performance and resolve disputes.
These responsibilities often create additional costs for consulting, contract management, compliance and oversight. Also, accountability can become fragmented, making it more difficult to identify responsibility for cost increases, member issues, clinical outcomes or service failures.4, 5
We can summarize some of the major comparisons:
No. Here are some of the reasons why.
Studies show that only 10% of employers with 500+ employees are "currently pursuing or planning to pursue" a distributed pharmacy services approach. That figure is not adoption; it includes potential future plans.6
Note that employers considering a distributed services model are typically looking at distributing only certain parts of their pharmacy benefits rather than fully dismantling their integrated pharmacy services relationship.7
Other reports indicate that most plan sponsors are still trying to understand the potential benefits, risks and operational implications of distributed pharmacy service arrangements rather than actively implementing them. Awareness is growing much faster than adoption.8
Interest in distributing services tends to increase with organizational size. Large employers are generally best positioned to pursue multiple vendors because they have:
These organizations are more likely to evaluate complex contracting strategies and explore distributing their pharmacy benefit services.9
Mid-sized employers often express interest in a distributed services model, but may lack the resources needed to manage multiple pharmacy service vendors directly.
For these organizations, partial distribution, such as contracting just for specialty pharmacy services or adopting transparent pharmacy services pricing, may be more practical than fully separating every pharmacy function.10
Many smaller employers depend on brokers, carriers or packaged health plans for benefit administration. So managing multiple vendor relationships can be challenging.11
Industry analyses indicate that organizations pursuing the distributed services approach frequently incur additional expenses related to vendor management, staffing, contract oversight and system integration. These should be considered when evaluating total cost of ownership.12
From a member perspective, individuals may need to navigate multiple points of contact, separate portals and varying processes to access medications, resolve issues or understand their coverage.13
Plan sponsors need to take this added complexity into account.
The central argument is that pharmacy services function best when clinical management, utilization management, claims processing specialty and member support operate together within a coordinated system. Plan sponsors and members benefit from centralized records, a tightly controlled data ecosystem and clear lines of accountability.
In general, Optum Rx believes that integration across pharmacy services makes care simpler and more connected for the people who use them.
It is important to note that it is now possible to achieve the goals of distributing pharmacy services without incurring the costs and complexity of managing multiple vendors.
Optum Rx has recently unveiled a new transparent pharmacy care model that fundamentally changes how pharmacy benefits are priced and delivered. This newly introduced Optum Rx pharmacy care model represents a structural shift, not an incremental improvement.
This model helps plan sponsors and employers improve predictability through fixed pricing and gives patients real-time visibility into medication costs, addressing some of the most persistent challenges in pharmacy care today.
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