The Myth of Complexity: Why PBMs Rely on Confusion and How Radical Clarity Restores Trust

By Scott Martin, CEO of Rescription

For decades, pharmacy benefit managers (PBMs) have built empires on the idea that complexity equals sophistication. The more confusing the terms, formulas, and contract structures become, the easier it is to justify opaque pricing and avoid accountability.

Rescription was founded to challenge that belief, especially for employers, brokers, third-party administrators, and health plans. True innovation doesn’t hide behind fine print: it exposes it.

The RFP Process: Theater, Not Analysis

PBM RFPs were designed to appear analytical and data-driven. However, the traditional process often functions as little more than well-produced theater.

Why RFPs Fall Short

• Predefined answers direct employers toward the same opaque pricing structures they already struggle with.

• Spreadsheet gymnastics mask the fact that key pricing data, like what a plan actually pays for individual drugs, is shielded from view.

• Proprietary definitions make it impossible to compare PBMs cleanly, even when the RFP framework suggests otherwise.

Employers walk away believing they’ve evaluated a competitive market. In reality, they’ve been guided through a curated performance. Read more about our thoughts on RFPs in our blog about the RFP process pitfalls.

Why Simplicity Threatens Entrenched Players

PBMs have no incentive to make pharmacy benefits easy to understand. For them, simplicity reduces margin opportunity. When employers understand the mechanics, they start asking the right questions, and the traditional model breaks down.

Radical Clarity Disrupts the Status Quo

• Clear unit-level pricing cuts through rebate theater.

• Open pricing algorithms eliminate the arbitrary classifications PBMs use to control spread.

• Straightforward contracts replace conditional language designed to obscure true cost.

• Insight into pharmacy reimbursements exposes where PBMs profit at the employer’s expense.

Simplicity isn’t naive. It’s dangerous only to those who rely on complexity as a business strategy.

The Cost of Not Knowing What You’re Paying For

Health plans and employers are expected to act as fiduciaries. Yet they are routinely denied access to the single most essential piece of fiduciary data: what they pay for each drug.

As I’ve said before:

"Employers don’t know what they’re paying for Ozempic or Lipitor, and somehow, that’s acceptable. You can’t be a fiduciary if you don’t know what you’re paying."

Without this visibility, plans cannot:

• Confirm whether discounts are real

• Validate rebates

• Identify waste

• Compare performance across PBMs

• Hold vendors accountable for cost increases

Bottom line: ignorance is expensive, not neutral

Restoring Trust Through Radical Clarity

Rescription was built on the belief that trust is earned through clarity, not complexity. Employers deserve:

• Real prices, not ranges

• Predictable spend, not spreadsheet illusions

• Contracts they can understand, not interpret

• Visibility into every unit and every reimbursement

When employers see what they’re paying, decision-making becomes faster, cleaner, and more strategic, making pharmacy benefits become sustainable instead of volatile.

The Path Forward: A Simpler, More Honest Pharmacy Benefit

PBMs will continue to argue that confusion is necessary, and that without complexity, pharmacy benefits cannot function. But the truth is simple:

Radical clarity isn’t the threat. It’s the solution.

Employers across the U.S. are already moving toward clearer pricing, cleaner contracts, and models that finally allow them to act as true fiduciaries

Rescription is helping lead that shift by proving every day that sophistication does not require complexity. It requires honesty.

Ready to transform your pharmacy spend? Connect with us today.