Trevor Daer, President and Founder of Granite Peak Analytics, reveals the hidden complexities of Pharmacy Benefit Managers (PBMs) and why specialized consulting is crucial for self-funded health plans. He shares his journey from corporate burnout to creating a company that helps employers navigate the convoluted PBM landscape and avoid overpaying for prescription benefits.

• PBM consulting helps benefits advisors navigate pharmacy complexity and secure better contracts for clients
• Granite Peak Analytics was founded after discovering independent pharmacies were being squeezed by PBMs while employers overpaid
• The pharmaceutical supply chain involves manufacturers, wholesalers (McKesson, Cardinal, AmeriSource Bergen), pharmacies, PBMs, and employers
• "The Big Three" PBMs (Optum, Express Scripts, CVS Caremark) control 80-85% of the market and are vertically integrated with insurance carriers
• PBMs have approximately 45 different revenue streams, creating misaligned incentives where they profit as drug costs increase
• Employers without specialized PBM consulting typically overpay by up to 50% on their pharmacy benefits
• Pharmacy costs have grown from 4-5% of self-funded plans to 25-30% today
• Rebates create perverse incentives where higher-cost drugs are often preferred over lower-cost alternatives
• Current trends include rising GLP-1 costs, specialty medications, and biosimilar adoption challenges
• Active management of pharmacy benefits is essential, especially with expensive new therapies