SHARx says pharmacy benefits have become one of the employer’s largest healthcare spend, yet responsibility remains fragmented across HR, finance, brokers, consultants, and PBMs, leaving no one clearly accountable for performance.

ST. LOUIS, July 27, 2026 /PRNewswire/ — Employers, regulators, and the media have spent years documenting the same problems in the prescription drug supply chain: rising costs, opaque contracts, limited transparency, and barriers that leave employees struggling to access medications. Yet the financial pressure keeps building. Large employers now project healthcare costs will rise 9% in 2026, while pharmacy continues to grow as a larger share of that burden, according to Paul Pruitt, Chief Growth Officer of SHARx, a procurement management solution for high-cost prescription drugs.

At the same time, the market itself has become more concentrated. The largest pharmacy benefit managers (PBMs) now control the majority of prescription claims, while employer decision-making around pharmacy benefits remains fragmented across HR, finance, brokers, consultants, and PBMs themselves. Pruitt calls this the accountability gap: One of an employer’s largest healthcare expenses is often managed without a clear owner, measurable performance standards, or accountability for outcomes. “Without accountability, there is no ownership,” said Pruitt. “If nobody is clearly responsible for whether the pharmacy benefit is delivering value, then nobody should be surprised when the spend keeps rising, the system keeps getting renewed, and employees keep dealing with the same barriers.”

A Critical Spend Category with No Clear Owner

Unlike cybersecurity, capital planning, or financial controls, pharmacy benefits are often managed across multiple stakeholders. HR may oversee benefits. Finance absorbs the budget pressure. Brokers and consultants influence purchasing decisions. PBMs operate the plan. Procurement helps evaluate vendors or negotiate contracts, but it rarely remains accountable for pharmacy performance.

That structure creates a gap between decision making and accountability. HR often manages PBM contracting, even though finance ultimately feels the long-term consequences in rising healthcare budgets, reduced flexibility, and cost shifting across the business. This is one reason PBM scrutiny has not translated into stronger employer control.

“Healthcare is often treated as a budget to absorb, not a system to manage,” Pruitt said. “Organizations keep relying on familiar structures and call that oversight. Meanwhile, the spend keeps rising and employees keep dealing with the same problems.”

Why Measurement Still Falls Short

Pharmacy performance rarely reaches the level of executive visibility it should. Federal Trade Commission (FTC) staff reported in 2024 that the top three PBMs, CVS Caremark, Express Scripts, and OptumRx, processed nearly 80% of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six processed more than 90%. The same report found that pharmacies affiliated with the three largest PBMs now account for nearly 70% of specialty drug revenue. Pruitt says those numbers help explain why pharmacy benefits should be treated less like a routine line item and more like a strategic area of governance.

McKinsey reported in 2024 that roughly 79% of jumbo employers (5,000+ employees) were using or planning to use methods to manage prescription drug costs, up by nearly 50% from 2021. Yet activity is not the same as accountability. “Employers are not lacking data,” Pruitt said. “They see pharmacy costs rising, but no one is accountable for acting on what the numbers show. The response is usually to change vendors or shift more of the cost to employees, neither of which addresses the problem.”

Oversight Theater Is Not a Governance Strategy

Audits may be useful for identifying whether terms were followed or whether a contract was drafted in a way that protects the plan. But they do not answer if the employer is getting the best deals. That concern is reinforced by federal findings on how the system behaves at scale. The U.S. Government Accountability Office (GAO) reported that Medicare Part D drug expenditures exceeded $200 billion in 2021 and that plan sponsors frequently gave preferred formulary placement to highly rebated brand-name drugs over lower-cost competitors. For Pruitt, that is a reminder that the problem is not simply whether a contract is being followed. “Auditing the deal is not fixing the problem,” Pruitt said. “Employers have to ask whether they are ever going to audit their way out of a system that was built to work this way.”

The Accountability Gap Keeping Pharmacy Costs Unchecked

Closing the accountability gap begins with treating pharmacy benefits like any other strategic spend category: with defined ownership, measurable expectations, and regular evaluation against business and employee outcomes.

That is where the next employer conversation should move: away from general frustration and toward operational accountability. Organizations that define ownership more clearly will be better positioned to control pharmacy spend, improve employee experience, and make smarter decisions about how benefits are governed.

That does not mean every organization needs the same internal structure. “Employers do not need more awareness of the problem,” Pruitt said. “They need clearer expectations, stronger accountability, and a willingness to reward better outcomes. If the dollars keep flowing to the same model, the model has no reason to change.”

About SHARx
SHARx was founded to fight back against the broken system of overpriced prescription drugs. Industry pioneers Corey Durbin and Paul Pruitt built SHARx to put people before profits. With an innovative and ethical sourcing model, SHARx cuts through the waste with radical transparency, common-sense cost containment, and a member-first approach. No hidden markups. No games. Just the meds people need, delivered affordably, reliably, and with dignity. Learn more at: SHARXplan.com  

Sources:

• Business Group on Health. (2025, August 19). Business Group on Health survey: 9% health care cost increase for 2026. businessgrouphealth.org/newsroom/news-and-press-releases/press-releases/2026-employer-health-care-strategy-survey
• Federal Trade Commission. (2024, July 9). FTC releases interim staff report on prescription drug middlemen. ftc.gov/news-events/news/press-releases/2024/07/ftc-releases-interim-staff-report-prescription-drug-middlemen
• Gupta, A., & Knott, D. (2025, June 26). Transforming employer health benefits: Large employers’ activist role. McKinsey & Company. mckinsey.com/industries/healthcare/our-insights/transforming-employer-health-benefits-large-employers-activist-role
• U.S. Government Accountability Office. (2023, September 5). Medicare Part D: CMS should monitor effects of rebates on plan formularies and beneficiary spending (GAO-23-105270). gao.gov/products/gao-23-105270

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