Big PBMs Retain Market Grip Thanks to Corporate Inertia, Optum Rx Discovers "Transparency" That Miraculously Protects Profit Margins, and A Federal Framework For Licensing AI Doctors

Hey all,

Happy Tuesday! The "Big 3" PBMs continue to gaslight HR departments into believing that administrative convenience is a fair trade for predatory pricing. Case in point Optum Rx announced that it is generously offering a "transparent" model that—shocker—miraculously preserves their profit margins. It seems the corporate world prefers the cozy, expensive embrace of the status quo over the minor "inconvenience" of actually fulfilling their fiduciary and moral duties.

Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

[HR Brew] Why most employers are sticking with Big 3 PBMs over alternatives

Despite mounting FTC scrutiny and the rise of transparent, fee-for-service competitors, most employers remain tethered to the "Big 3" PBMs to avoid the administrative complexity and potential employee backlash associated with changing drug formularies. While early adopters like Purdue University have achieved significant savings and better clinical reporting by switching to smaller providers, the majority of HR leaders are prioritized by the fear that radical cost-cutting might lead to widespread worker dissatisfaction. This highlights a persistent tension in corporate benefits where the perceived safety of the status quo often outweighs the fiduciary duty to lower prescription costs. Because clearly, the best way to show your employees you value them is to let them keep overpaying for life-saving medication just so HR doesn't have to deal with the "heavy lift" of a new spreadsheet.

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[Endpoints News] Optum Rx Unveils New Transparent Pharmacy Pricing Model

Optum Rx is launching a new pharmacy benefit model for 2027 that eliminates spread pricing in favor of flat monthly fees and passes 100% of manufacturer rebates directly to employers and health plans. This structure allows clients to audit drug-level costs and rebates across the entire supply chain, effectively decoupling PBM reimbursement from the fluctuating list prices of prescription drugs. While the company is framing this as a revolutionary move toward transparency to appease grumpy lawmakers, CEO Patrick Conway was quick to reassure investors that they’ve miraculously found a way to be "fully transparent" while keeping their 3% to 4% margins perfectly intact—because apparently, the only thing more crystal clear than their new fee structure is their commitment to never making a penny less than they already do.

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[STAT News] A Federal Framework for Licensing Autonomous Clinical AI

Experts propose a federal licensing framework for autonomous clinical AI to move past the FDA’s static device-approval process and the fragmented state-level regulations highlighted by Utah’s recent Doctronic pilot suspension. This proposed model requires AI to prove competency through standardized testing and supervised clinical deployment—similar to human residency—before receiving a time-limited license for a specific scope of practice. Implementing a national competency standard through a dedicated federal office would finally allow software to bypass the archaic "state-by-state" licensing gauntlet that currently forces human doctors to collect expensive paper certificates like they’re playing a very depressing, bureaucratic version of Pokémon.

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