Show Your Work: The Revenue Conversation PBMs Don’t Want to Have

Let’s talk about the question that usually comes with a pause and a hint of hesitation:

“So… how do you actually make money?”

I get it. The pharmacy benefits space has trained people to expect smoke and mirrors. Between spread pricing, rebates, volume incentives, and tied-in mail-order or specialty arrangements, most PBMs have made it painfully difficult to follow the money. And when you can’t trace the revenue, you can’t fully trust the value.

But the difference with ChoiceScripts is that not only do we expect you to ask that question, but we also want you to know the real answer.

The Truth About PBMs Shouldn’t Be a Trade Secret

At ChoiceScripts, transparency is the principle we’re built on. Our revenue model is simple: we charge a clear administrative fee, which is agreed upon, documented, and fully visible from the start. That fee covers everything we do, from benefit design to clinical support to real-time reporting. Nothing hidden. Nothing buried in the fine print. No surprise invoices tied to someone else’s margin.

And no, we’re not a pharmacy. We don’t make a dime off the dispensing of medications.
We don’t inflate pricing behind the scenes or steer members into higher-cost options to pad our bottom line.

That’s the kind of stuff that’s fueled this industry’s credibility crisis. We chose a different path, one that puts our clients and their members at the center.

Transparency Is More Than Data Access

I spent two decades managing a hospital pharmacy, where I saw the consequences of pharmacy benefit decisions play out in real time. Patients confused by what was covered and why, providers navigating roadblocks they didn’t create, and employers stuck in plans that lacked clarity and flexibility. From that vantage point, it was obvious something was broken.

So, when we say transparency, we’re not just talking about access to data; we’re talking about understanding. This comes through things like a consultative relationship with your PBM, real-time dashboards, and clear contract terms. And yes, full visibility into how we earn revenue. Because you can’t make confident decisions for your members or your business if you don’t have the full picture. And too many PBMs are banking on that.

At ChoiceScripts, we hand you the blueprints to your pharmacy plan. Every dollar, every driver, every outcome—you see it all.

What Scale Should Look Like

Even though we don’t make our money through back-end deals or markups, we still deliver pricing that competes with the big guys. How? By leveraging the collective negotiating power and deep industry expertise to obtain market-leading contract pricing with partners like Prime Therapeutics. This allows our downstream clients to benefit from scale without sacrificing flexibility or control.

The fact is that the traditional PBM model was never designed to prioritize the plan sponsor. It was designed to prioritize the system. And if you’re not questioning that model, you’re probably paying more than you should, for less than you deserve.

Final Thought: Ask the Hard Questions

The industry needs more people asking hard questions. Not just “how much am I saving?” but “how are you making money off my plan?”

At ChoiceScripts, we show our work. We don’t make revenue complicated, because we don’t need to. Our business grows when our clients thrive, not when they stay in the dark.

So go ahead. Keep asking. Keep challenging. Keep pushing for something better.
We’ll be right here, ready to answer with clarity, data, and purpose.