With federal regulators intensifying scrutiny of PBM practices and employers facing mounting ERISA and CAA-2021 fiduciary exposure, the need for a fiduciary compliant, conflict-free pharmacy benefits model has never been more urgent. US-Rx Care— the nation’s first fiduciary PBM—delivers a legally aligned, clinically rigorous, and financially transparent alternative that consistently reduces plan and member costs by 30–50%.
HOLLYWOOD, Fla., Dec. 17, 2025 /PRNewswire/ — A wave of federal scrutiny is exposing how legacy pharmacy benefit managers (PBMs) inflate drug costs and expose employers to potential legal jeopardy. Recent Federal Trade Commission (FTC) findings of drug dispensing from 2017 to 2022 uncovered $7.3 billion in PBM markups on specialty generics dispensed in PBM-owned pharmacies. The FTC uncovered another $1.4 billion in markups on prescriptions dispensed by pharmacies, confirming that vertically integrated PBMs profit from high drug prices. These practices have led to lawsuits against major employers over alleged Employee Retirement Income Security Act (ERISA) and Consolidated Appropriations Act (CAA-2021) violations tied to PBM contract misalignment that drives up prescription drug costs for plan enrollees.
US-Rx Care, founded in 2007 as the nation’s first fiduciary PBM, argues that the solution is clear: PBMs must be legally bound to act in the best interest of the plan and its members—not themselves.
“Most PBMs steer utilization to maximize their own profits,” said Renzo Luzzatti, President & CEO. “A true fiduciary PBM removes every financial conflict and is focused solely on delivering better outcomes at the lowest available cost.” That’s the standard ERISA requires, and the standard employers need.”
PBM Opacity Drives Costs and Employer Liability
The FTC’s latest findings deliver the strongest evidence to date that PBM incentives are fundamentally misaligned, putting PBM financial interests above all – with employers and patients picking up the tab. Among key FTC findings were:
- The “Big 3” PBMs imposed hundreds to thousands of percent markups on specialty generics.
- PBM-owned pharmacies captured disproportionate shares of the most profitable prescriptions.
- PBMs steered patients to their own pharmacies and reimbursed them at higher rates than independents.
- Spread pricing alone generated $1.4 billion in PBM profit on medications dispensed by retail pharmacies.
- Plan sponsors and patients saw spending grow at double-digit rates, with 21% annual increases in commercial claims.
- Lower-cost drugs were excluded from formularies in favor of high-rebate, high-cost alternatives.
These findings confirm what employers have long experienced: PBMs profit when plan spending goes up, not down, which in turn creates a disincentive for PBMs to lower costs. As more unsavory PBM practices come to light, employers face not only unprecedented costs, but also fiduciary liability if they continue relying on traditional, conflict-ridden PBM service contracts.
Fiduciary PBM Model: Built for Compliance and Cost Reduction
US-Rx Care pioneered the fiduciary PBM model in 2007, operating under three non-negotiable ERISA principles: No conflicts of interest; act solely in the interest of the plan and its members and provide full transparency of all financial and utilization data. This means:
- No pharmacy ownership.
- 100% pass-through of rebates, discounts, and manufacturer revenue.
- Clinical decisions based solely on safety, effectiveness, and lowest net cost.
- Complete alignment with employers’ own fiduciary duties under ERISA.
“Transparency alone isn’t enough,” said Luzzatti. “It’s not a word that is quantifiable nor has any legal meaning, and it still allows PBMs to define the rules. Fiduciary accountability eliminates all conflicted revenue streams and all self-dealing.” “Employers using US-Rx Care consistently see 30–50% lower pharmacy spend in year one—validated independently by the Validation Institute—and roughly 30% lower costs for members.
Right Rx™: Delivering Real-World Savings at Scale
Among several core technologies delivering measurable cost savings is US-Rx Care’s Right Rx™ platform which monitors pharmacy claims to identify and target over 2,500 cost savings and quality improvement scenarios across all clients. The platform engages prescribers directly and secures more than 70% clinician approval for lower-cost, equally effective therapies. More than 80% of members accept their prescriber approved changes, delivering large, immediate, and sustained savings for both plan sponsors and members.
“Employers don’t need another spreadsheet,” Luzzatti said. “They need real pharmacy risk management. Right Rx gives them a doctor and member friendly path to better outcomes and lower cost.”
A Ready-Now Solution Aligned with All Major Reform Goals
As Congress, the FTC, and AMA push for PBM reform, the fiduciary PBM model is emerging as the inevitable future. But employers don’t need to wait for legislation. They can meet and be fully compliant with their fiduciary-duty requirements today by engaging a PBM like US-Rx Care bound by the same ERISA standards as plan sponsors.
“Legacy PBMs have shown what happens when profit comes before patients—higher costs, opaque contracts, and rising litigation,” said Luzzatti. “US-Rx Care proves the benefit when a PBM puts employers and members first.”
For more information about US-Rx Care’s fiduciary PBM services, visit US-Rx Care.
About US-Rx Care
US-Rx Care is revolutionizing America’s pharmacy benefits system by replacing opaque, profit-driven PBMs with a transparent, fiduciary model that puts employers and members first. Founded in 2007, the company combines clinical rigor, ethical contracting, and data-driven oversight to cut drug costs by up to 50% or more while also improving health outcomes. Operating under a legally binding ERISA fiduciary standard, US-Rx Care eliminates conflicts of interest, passes through 100% of manufacturer rebates and pharmacy discounts, and delivers measurable savings without compromising care. Privately owned and free from outside financial influence, US-Rx Care is setting the new standard for pharmacy benefit management—restoring trust, accountability, and real control for employers, benefits consultants, and health plans nationwide.
Website: www.us-rxcare.com
References:
- Federal Trade Commission. (2024, July). Pharmacy benefit managers: The powerful middlemen inflating drug costs and squeezing Main Street pharmacies – Interim staff report. U.S. Government Printing Office.
- Federal Trade Commission. (2025, January 14). FTC releases second interim staff report on prescription drug middlemen.
- Martin, K. (2025, March 17). What pharmacy benefit managers do — and how they contribute to drug spending. The Commonwealth Fund.
- National Alliance of Healthcare Purchaser Coalitions. (2023, June). Addressing pharmacy benefit management misalignment.
- Abrams, L. W. (2025, March 13). A pharmacy benefit manager insurance business model.
- Mayer, K. (2025, June 6). How much of employers’ annual claims do GLP-1 drugs account for? SHRM.
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