The Missing Piece in HR’s Benefits Strategy: An Internal Pharmacy Benefit Team
Most HR departments don’t have a pharmacy benefit team. They rely on brokers or health plan reps to manage the PBM, rarely dig into pharmacy-specific metrics, and assume someone else is watching the details. But pharmacy benefits are where the real complexity and often the greatest waste lives.
If you’re in HR and pharmacy benefits are buried in your broader health plan workflow, this is your opportunity. A small, focused team or even just the right external partners can unlock savings, improve member outcomes, and give your plan the transparency it deserves.
Here’s how smart HR leaders are making it happen.
Start With a Fiduciary Mindset
Pharmacy benefits shouldn’t be managed as just another health plan line item. Most PBMs operate on a profit model that rewards opacity and misalignment. The only way around that is to establish fiduciary-level oversight, acting solely in the best interest of your plan and its members.
Even if you don’t have internal pharmacy experts, you can adopt a fiduciary mindset by bringing in partners who work exclusively for you. That means no commissions, no hidden fees, and no loyalty to anyone but your plan.
The Roles That Matter Most
You don’t need a new department. But you do need someone thinking about pharmacy every day. That might mean reallocating responsibilities within HR or outsourcing to fiduciary-aligned consultants. These are the core roles worth investing in:
- Pharmacy Benefit Strategist Brings experience from inside the PBM world. Knows what to ask, what to audit, and how to negotiate terms that actually protect your plan.
- Contract and Procurement Lead Reviews PBM contracts with a fine-tooth comb. Looks for soft guarantees, ambiguous language, and misaligned incentives.
- Data Analyst or Actuarial Support Translates raw claims into clear insights. Helps model new benefit designs, forecast impact, and identify cost drivers.
- Clinical Oversight (Pharmacist or Consultant) Ensures utilization management is rooted in evidence, not just cost-shifting. Essential for specialty, GLP-1s, and PA protocols.
- Project Manager or Implementation Lead Keeps audits, vendor changes, and benefit updates on track. Without this role, good strategy gets stuck in limbo.
Strengthen Your Oversight to Get More from Your PBM Relationship
Your PBM plays a critical role in managing drug costs, access, and outcomes. Like any complex vendor relationship, the more engaged and informed your team is, the better results you will see.
A dedicated pharmacy benefit team allows HR to become an active participant in decision-making rather than just a recipient of updates. This improves the PBM partnership by bringing more clarity, better communication, and shared accountability.
When your team is prepared to review data, manage contracts, and provide clinical insight, it creates the structure for a stronger partnership. Your PBM can focus on delivering value, while your team ensures that value aligns with your plan’s goals. It’s not about stepping on toes. It’s about stepping up.
Build Audit and Oversight Into Your Routine
Oversight isn’t just an annual rebate check. A good pharmacy benefit team will regularly review:
- Rebate guarantees and actual pass-through
- Formulary changes and exclusions
- Prior authorization outcomes
- Specialty drug channel utilization
- MAC pricing accuracy
These audits don’t need to be in-house, but your team should know what to look for and when to push back.
Invest in Education
Pharmacy is the fastest-evolving part of your health plan. New therapies, pricing schemes, and legislative changes hit every quarter. If your team isn’t staying current, it’s easy to fall behind and costly when you do.
Certifications like the CPBS (Certified Pharmacy Benefits Specialist) can bring your team up to speed quickly and create a common language between HR, finance, and procurement.
Start Small. Just Start.
One employer we worked with started with just three people: the benefits manager, an ERISA attorney, and a part-time pharmacist consultant. They didn’t restructure HR. They just shifted focus and brought in help where needed. Within six months, they uncovered overcharges, corrected rebate discrepancies, and improved member experience through better utilization review.
You don’t need to build a large team. You need a focused one with the right questions, tools, and accountability measures in place.
Conclusion
The missing piece in most HR benefits strategies isn’t a better PBM. It’s a better approach to oversight. Building even a small pharmacy benefit team puts you back in control and turns your benefit plan into a strategic asset.
Ready to get started? Let’s talk about how to build the right structure for your organization: lean, focused, and built to protect your plan.