How disintermediation is being managed in Rx models 

Fewer employers are relying on a traditional pharmacy benefit manager (PBM) model to run their entire Rx program. Use of transparent PBMs among employers increased to 31% in 2025 last year from 12% in 2024, according to the National Alliance of Healthcare Purchaser Coalitions.

For brokers and consultants, this shift shows up across the book of business as a move toward disintermediation. In practice, plan sponsors are unbundling the traditional PBM model and moving to a multi-vendor configuration, whether that means changing PBM contracting structures, carving out specialty management, or layering clinical navigation and other partners alongside the PBM.

This approach can expand choice and control, but it can also fragment measurement. Brokers and consultants are asked to reconcile PBM claims files, rebate and guarantee reconciliation reports, specialty partner reporting and clinical navigation outputs. The goal is a single, renewal-ready view of net cost, trend drivers and what actually moved performance. 

That's where a neutral-optimization layer comes in. If it is physician-directed and clinically grounded, then it can successfully work alongside the PBM to identify lower-net-cost alternatives, biosimilar opportunities and waste from duplicate therapy or polypharmacy. Recommendations flow through prescribers, allowing plan sponsors and their advisers to document measurable savings. 

That's the gap brokers are being pulled into. They're turning disconnected partner reports into a single story that stands up at renewal. Closing it takes more than better spreadsheets. It requires a neutral-optimization layer that can translate clinical opportunity into documented, finance-ready results.

Disintermediation can improve control, but it also spreads accountability across multiple partners. Each partner can credibly report progress in its lane, specialty performance, formulary alignment, utilization outcomes and financial guarantees. The problem is that those reports are rarely built to reconcile into one renewal-ready performance view.

Brokers and consultants are left having to connect PBM claims experience, carve-out and point-solution reporting and rebate or guarantee true-ups that arrive on different timelines and use different methodologies. The result is a familiar renewal dynamic: multiple "wins," but no single, defensible answer to what happened to net cost and what drove it.

This visibility gap is exactly what neutral optimization is designed to close.

Neutral optimization in practice

A neutral-optimization layer works alongside the PBM and other pharmacy partners to surface clinically grounded cost opportunities and document their impact, especially the kinds of pharmacy waste that plan design alone doesn't consistently capture.

It typically supports brokers and plan sponsors in three ways:

• Therapeutic opportunity: Identifies clinically equivalent, lower-net-cost options, including generics and biosimilars and pinpoints where a switch is clinically appropriate.
• Waste reduction: Flags avoidable utilization patterns, including duplicate therapy, polypharmacy and other high-cost/low-value spend that can hide inside specialty and navigation reporting.
• Renewal-ready proof: Produces broker-ready reporting that shows what changed, the net savings impact and where opportunities remain. That way renewal conversations are rooted in the same set of facts.

In practice, that translates into a few repeatable broker-use cases:

• Building a renewal baseline: Creating a unified view of net drug cost drivers across fragmented dashboards and vendor reports so brokers can isolate where spend is concentrated and prioritize interventions at the medication level.
• Prioritizing low-disruption actions: Making waste patterns visible so brokers can focus on clinically appropriate moves that reduce spend without creating unnecessary friction for members.
• Reconciling performance and guarantees: Bringing clarity to net cost when rebate structures or guarantee reporting muddy the picture, helping plan sponsors validate what was promised vs. what was delivered and keeping renewal discussions focused on outcomes and next steps. 

Before recommending a neutral-optimization layer, brokers should pressure-test two basics. First, can the partner show exactly how savings are calculated, including what data is used and how overlap with other programs is handled? Second, does the employer retain access to the reporting and is there clinical oversight behind the recommendations?
The answers will likely tell you whether the layer will sharpen renewal visibility or create more reporting to manage. Once that's clear, the question becomes how brokers operationalize it and use the results in renewal conversations.

Most brokers don't need to overhaul the pharmacy benefit to make disintermediation work. The practical move is to set the measurement path early. That means mapping the employer's pharmacy configuration, confirming where the source-of-truth data lives, and establishing a baseline for net cost and the top two or three drivers.

At renewal, brokers should walk in with three things: a baseline vs. current trend view, documented savings tied to specific interventions and a reconciliation check on guarantees and rebates. When those are clear, disintermediation becomes manageable, because the employer can see what changed, what it delivered and what to do next.