The $400 Billion Verification Gap
Drug Benefit Integrity is the independent standard for evaluating whether pharmacy benefit decisions are made - and verified - in the plan's interest.
The Problem
In today's pharmacy benefit structure, the entities making routing decisions often have financial relationships with the dispensing channels being evaluated. Manufacturer-funded programs - while valuable - frequently operate outside the benefit, creating gaps in visibility and coordination.
Transparency shows what happened. Integrity proves it happened right.
Transparency vs. Integrity
Transparency
- Shows what happened after the fact
- Produced by the entity that made the decision
- Structural overlap remains
Integrity
- Ensures it happened right in the first place
- Produced by an independent party with no channel interest
- Structural independence is built in
Who Benefits
Plan Fiduciaries
Independent documentation meeting ERISA prudent expert standards and CAA audit requirements.
Benefits Consultants
A structural standard that changes the question from “Is this a good deal?” to “Does this have integrity?”
PBMs & Health Plans
A competitive differentiator. Independent verification demonstrates operational integrity to clients and prospects.