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Rising drug costs, lack of transparency, and poor support are prompting many plan sponsors to seek new pharmacy benefit management (PBM) solutions that truly deliver on their promises. National CooperativeRx was founded to solve these issues and has been a trusted partner to plan sponsors and patients for over 20 years. Below, we outline common challenges plan sponsors face and explain how National CooperativeRx helps overcome them.
Common Challenges and National CooperativeRx’s Difference
Challenge: Escalating Costs/Poor Cost Management
Industry reports show overall pharmacy benefit cost trends ranged from 8% to 12% in 2024. When a PBM arrangement does not offer competitive contract pricing, perform regular market checks, or deliver effective plan design and clinical strategies, plans become vulnerable to escalating pharmacy benefit costs.
Our Difference: At National CooperativeRx, we take a proactive approach to controlling pharmacy benefit costs through our best-in-class PBM contract, combined with our expert plan design and clinical guidance. Compared to others in the industry, our membership saw a notably lower overall trend of 5.6%, with specialty trend coming in at just 2.5%.
At the core of our success is our PBM contract. We negotiate one master contract that secures industry-leading discounts, favorable terms and definitions, and 100% pass-through of rebates, audit recoveries, market check savings, and net earnings. Member groups sign on directly to this contract and receive the full benefits of our negotiations.
Through our in-house, no-additional-cost clinical programs, we deliver further value by effectively managing high-cost therapies, new-to-market drugs, and emerging trends. These programs provide independent oversight beyond PBM offerings and promote appropriate utilization of clinically sound, lower-cost therapy alternatives.
We continuously monitor industry drug trends and develop innovative clinical offerings to meet our members’ evolving needs. For example, to stay ahead of costly GLP-1 trends, we introduced an optional custom approach to antidiabetic GLP-1 management in 2024. Additionally, in August 2025, we will launch a home-based light therapy program to help further manage psoriasis spend.
In 2024, our clinical programs resulted in more than $66 million in cost avoidance across our membership, demonstrating the tangible impact of our initiatives.
Challenge: Lack of Transparency in Contracts and Reporting
Complex contracts with vague definitions and hidden revenue streams, such as retained rebates or inflated administrative fees, often undermine transparency for plan sponsors. This lack of clarity makes it challenging for plan sponsors to fully understand the true value of their contract and ensure fair, honest pricing.
PBM arrangements may also restrict access to plan data and detailed, actionable reporting. This limits a plan sponsor’s ability to identify savings opportunities, hold the PBM accountable to contract terms, and increases the risk of misaligned incentives between the PBM and the plan.
Our Difference: As a not-for-profit, member-owned cooperative, National CooperativeRx operates in the best interests of members and free from misaligned incentives. With full access to our master contract and comprehensive plan data and reporting, plan sponsors are empowered to evaluate their plan’s performance.
To ensure accountability, we conduct ongoing audits and enlist independent third-party auditors to review 100% of claims and rebates at no cost to our members. These audits verify contract compliance and accurate rebate allocation, and 100% of recoveries are passed through to our members.
Challenge: Limited Plan Design Flexibility and Customization
Plan sponsors often feel boxed in by one-size-fits-all plan designs that overlook the distinct needs of their population and long-term objectives. Without flexibility, it becomes difficult to tailor strategies, address specific challenges, or improve outcomes in a way that truly aligns with plan’s goals.
Our Difference: At National CooperativeRx, we recognize no two member groups are the same. While all members benefit from the same negotiated contract, every plan can be customized, whether through formulary design, cost-sharing structures, clinical programs, and more. Our flexible approach allows plans to adapt as patient needs evolve, new therapies emerge, or priorities shift—helping plan sponsors manage costs and improve outcomes for the long term.
Challenge: Minimal Support and Engagement
Some PBM arrangements fall short in providing customer service and guidance. Without clear communication, education, and ongoing assistance, plan sponsors are often left to navigate complex plan details and manage patient concerns on their own. This lack of support not only reduces plan satisfaction but also contributes to higher costs and potentially poorer health outcomes.
Our Difference: At National CooperativeRx, our members benefit from two dedicated support teams: our PBM partner CVS Caremark’s team, and our in-house account team at National CooperativeRx.
CVS Caremark’s team is dedicated to customer care and supporting day-to-day operations. Plan sponsors have a dedicated point of contact at CVS Caremark to assist with questions, requests, and escalated patient issues. Additionally, CVS Caremark operates a 24/7 customer care call center where patients can refill prescriptions, check order status, and receive assistance with escalated inquiries. CVS Caremark’s web-based portal and mobile app further enhance the patient experience by providing easy access to benefit details, personalized savings opportunities, drug coverage information, and more. CVS Caremark also offers patient-facing educational resources designed to inform and promote medication adherence.
National CooperativeRx’s team concentrates on strategic oversight, plan design, and plan performance management. Plan sponsors have a dedicated point of contact for questions, performance inquiries and reviews, proactive recommendations, and ongoing strategic planning. Throughout the year, the National CooperativeRx team delivers tailored recommendations and insights to help plans stay aligned with both their financial objectives and patient care priorities.
Together, our teams are committed to delivering exceptional service and support to plan sponsors and their patients.
Solve For Your Pharmacy Benefit Pain Points with National CooperativeRx
Managing pharmacy benefits effectively requires a trusted partner who delivers adaptable solutions, transparency, and dedicated support every step of the way. National CooperativeRx is that partner—providing the expertise, innovative strategies, and exceptional service plan sponsors need to optimize their pharmacy benefits and drive sustainable savings.
Ready to reduce costs, improve plan performance, and enhance patient satisfaction? Connect with National CooperativeRx today to learn how we can help.
