By: Nic Hayes
"The single word that has made the pharmacy industry so dirty is conflict."
– Bill Miller, Managing Director, Evo First
In the labyrinth of rising pharmacy costs, one culprit often goes unnoticed: conflict of interest. For years, the largest pharmacy benefit managers (PBMs) have operated with opaque practices, quietly driving up costs for plan sponsors. These conflicts manifest in ways that are hard to see but impossible to ignore, rebates that never make it back to the plan, spread pricing that pads profits, and exclusive networks that steer patients into the PBM’s own high-cost services.
But it doesn’t have to be this way. At Evo First, we believe transparency isn’t just a buzzword, it’s a path to reclaiming control over your plan’s pharmacy spend and reshaping the way benefits are delivered.
The Rebate Maze
Rebates are supposed to lower costs, right? Pharmaceutical manufacturers pay rebates to PBMs based on the volume of a drug sold. But here’s the twist: many PBMs siphon off these funds, disguising them as administrative fees, marketing budgets, or other nebulous charges. The result? Plan sponsors receive only a fraction of what they’re owed—or worse, nothing at all.
At Evo, we don’t keep any rebate money. Every rebate dollar we receive is passed back to the plan.
Spread Pricing: The Silent Surcharge
When you hear "spread pricing," think of a sleight of hand. PBMs pay pharmacies one price for a prescription and charge the plan something far higher, pocketing the difference. This gap, hidden from view, represents pure profit for the PBM at the plan’s expense.
Evo First operates differently. We believe in pass-through pricing, where the cost from the pharmacy is the cost you pay. No markups, no hidden margins.
Exclusive Networks: Profit Over Patients
Imagine a PBM that owns its own specialty pharmacy. Instead of finding the best prices for patients, they funnel prescriptions to their own facilities—even if those services are more expensive. This conflict of interest isn’t just bad for the plan’s bottom line, it’s a betrayal of trust.
Evo is fiercely independent. We prioritize what’s best for the plan and its members, and align our financial interests with the plan.
Empowering the Plan
Transparency isn’t just a feature; it’s the foundation of Evo First. By eliminating conflicts, we align our incentives with those of the plan. We don’t take revenue from manufacturers. We don’t pocket rebates. Instead, we charge a straightforward administrative fee and dedicate ourselves to lowering costs and customizing benefits to meet each plan’s unique needs.
For example, if a plan struggles with high diabetes medication usage, Evo partners with the plan to create targeted programs. We integrate seamlessly, ensuring that solutions work holistically, not as bolt-ons but as tailored answers to real challenges.
The Value of Transparency: A Real Story
Bill Miller, Managing Director at Evo First, experienced this firsthand. On a recent pharmacy visit, he was shocked when his statin and fish oil prescriptions cost $86 and $300, respectively, using a "big-three" PBM card. When he asked the pharmacist to run the same prescriptions on his Evo card, the statin dropped to $8.16 and the fish oil to $66, a savings of over $300.
The lesson is clear: when you strip away conflicts, the value speaks for itself. Evo doesn’t just lower costs, it empowers plans to take control, tackle challenges, and deliver better outcomes for their members.
The Choice Is Yours
The pharmacy industry doesn’t have to be dirty. With Evo, you gain a partner who’s as invested in your success as you are, because when your plan wins, we all do.
We are proud to feature Evo First on the Granite List.