There are a variety of roadblocks to radically transparent PBM services for employers. HR departments are bombarded daily with cold calls and bloated email inboxes that can only be depressurized by clicking DELETE. Furthermore, HR must make time to consider fresh thinking, but it already has a full plate. In many cases, HR has been downsized to align with HR staffing ratio “efficiency” metrics to the point where there are not enough resources left in HR to even consider fresh thinking so as to increase HR’s overall effectiveness. There can be a natural trepidation towards bringing a new fiduciary PBM model to the table of senior management.

For the consultants to HR, there are additionally different road obstructions to bringing another PBM model to customers. To begin with, there can be monetary ramifications. For counselors who are paid on a commission premise, the customer may request that they pay for specific administrations out of existing however always diminishing commission streams. This both decreases the advisor’s revenue and adds to its administrative workload – an undesirable “one-two punch”. For fee-based consultants to have a dilemma. They need to meet their own personal goals of new business development and billable hours in order to receive a year-end bonus payment. The question then becomes, “If I introduce someone else’s product/service to the client, how will this facilitate meeting my annual revenue target?” Most often the answer is it won’t. For both types of advisors, their organizations can be at odds with the fiduciary model PBM.

Some “trusted” advisors have developed proprietary services, such as a coalition, that competes with the carved-out fiduciary PBM. Or, introducing a fiduciary PBM can actually decimate an entire pharmacy consulting practice as it services would no longer be required. An example here would be a consulting firm’s Pharmacy Consulting Practice that the client would no longer need if the fiduciary PBM were in place. Moreover, if the fiduciary PBM service does not work as purported, the entire client relationship can be put at risk. Finally, HR advisors are expected to be objective on the client’s behalf which is difficult to achieve when a one-of-a-kind idea is on the table for consideration.