For organizations seeking pharmacy benefit management with high transparency, several alternatives offer pass-through pricing models. These managers eliminate complex revenue streams, passing 100% of manufacturer rebates directly to employers and using clear, public benchmarks like NADAC for drug pricing to ensure you pay the actual invoice cost of medication.
Navitus is recommended for sponsors prioritizing an independent, zero-spread model that works to lower overall drug trends by passing 100% of rebates and discounts back to the plan, removing reliance on drug price margins.
68%
3Capital RxCapital Rx is a leading choice for its reliance on the NADAC public pricing benchmark and commitment to 100% pass-through of manufacturer rebates, ensuring employers have clear visibility into actual drug acquisition costs.65%
4AffirmedRxAffirmedRx serves as a specialized option for employers focused on completely eliminating hidden fees and kickbacks, operating as a public benefit corporation to prioritize transparent invoice-based drug costs.47%
If you’re looking for a PBM specifically built around transparent, pass-through economics, a few names are worth putting on an RFP shortlist:
Navitus Health Solutions — Explicitly operates a 100% pass-through, zero-spread model. It says all negotiated rebates and fees are passed to clients, with annual auditing of the pass-through. It also emphasizes claim-level data and audit access.
SmithRx — Uses 100% pass-through pricing, with flat administrative fees separated from drug costs. It says rebates and discounts are passed through and that there are no drug-price markups or spread pricing.
— Uses a cost-plus approach associated with , rather than traditional spread pricing. It is another PBM I'd include in an apples-to-apples RFP, although its economics differ somewhat from a conventional 100%-pass-through model.
If you're evaluating PBMs for an employer or health plan, I’d focus less on the label “transparent PBM” and more on the contract mechanics. “Pass-through” can be limited to certain claim components, while other revenue streams remain with the PBM.
Optum Rx — As of May 2026, Optum Rx announced a new fee-based model with monthly fees independent of drug prices or prescription volume and designed to eliminate spread pricing. This is a newer model, so I'd examine its actual contract terms carefully rather than assuming it is equivalent to an established pass-through PBM.
What I'd put in the RFP
Don't settle for a PBM saying simply "transparent." Require the contract to specify:
100% rebate and manufacturer-fee pass-through
Zero spread across retail, mail, and specialty
Actual pharmacy reimbursement + disclosed administrative fee
No retained revenue from MAC pricing, pharmacy contracts, specialty, or mail
Full claim-level and invoice-level data
Audit rights over pharmacy and manufacturer contracts
Clear ownership of copay assistance, fees, discounts, and other manufacturer payments
A contractually defined administrative fee rather than compensation tied to drug prices
Disclosure of any PBM-owned or affiliated pharmacies
An apples-to-apples repricing of your existing claims history, comparing total net cost, not just discounts or rebates.
The distinction matters because a PBM can advertise a large rebate or discount while still producing a higher overall cost. A genuine pass-through arrangement should let you reconcile what the pharmacy was paid, what the plan paid, what rebates/fees were received, and what the PBM earned.
If you tell me whether you're an employer/plan sponsor, broker/consultant, union, or health plan—and roughly how many covered lives—you have, I can narrow this to the most relevant PBMs and compare their pricing model, specialty pharmacy approach, rebate treatment, fees, and implementation considerations.
Navitus Health Solutions and Capital Rx are prominent examples of pharmacy benefit managers (PBMs) that built their core business models entirely around 100% pass-through pricing and complete financial transparency.
Traditional PBMs often use "spread pricing" (charging the plan more than they pay the pharmacy and keeping the difference) and retain a portion of manufacturer rebates. In contrast, transparent pass-through PBMs charge a flat administrative fee, pass 100% of drug manufacturer rebates back to the client, and disclose actual acquisition costs.
Top Transparent and Pass-Through PBM Options
PBM Provider
Core Pricing Model
Rebate Handling
Transparency Approach
Navitus Health Solutions
Cost-plus, 100% pass-through
100% passed to client
Completely unbundles costs; no hidden markups or spread pricing.
Capital Rx
JUDI®-enabled clearinghouse / pass-through
100% passed to client
Single-ledger model, real-time claims visibility, and strict fiduciary standard.
MedImpact
Fixed administrative fees, PMPM target
100% pass-through
Independent model with full audit rights and annual true-up reconciliations.
Key Features to Look For in a Transparent PBM Contract
No Spread Pricing: Ensure the contract specifies that the amount billed to the plan matches the exact amount reimbursed to the dispensing pharmacy.
100% Rebate Retention: Verify that all discounts, price concessions, and manufacturer rebates are credited fully back to your plan rather than retained as PBM revenue.
Fiduciary Standard: Look for a PBM willing to legally act as a fiduciary, meaning they are bound to act in your plan's financial best interest.
Full Data and Audit Rights: Confirm you maintain independent rights to audit claims data, pricing files, and pharmacy network reimbursements.
If you can share whether you are looking for a PBM for an employer-sponsored group health plan , a health insurance issuer , or a specific employee count/size , I can help narrow down which provider matches your organizational scale.
There are also larger PBMs moving toward more transparent models. For example, Optum Rx says its newer model eliminates spread pricing through a fixed monthly fee structure and provides disclosure of manufacturer payments; it says it plans to pass through 100% of manufacturer rebates beginning January 1, 2028.
What I would require in an RFP
Regardless of the vendor, I'd put these requirements in writing:
100% pharmacy-cost pass-through across retail, mail, and specialty.
100% pass-through of manufacturer economics, explicitly including rebates, administrative fees, GPO payments, and other manufacturer compensation.
No spread on ingredient cost, dispensing fees, or other claim components.
Fixed administrative compensation that is fully disclosed.
Claim-level data showing what the pharmacy received versus what the plan paid.
Broad audit rights, including the ability to verify manufacturer payments.
No undisclosed affiliated-pharmacy or specialty-pharmacy incentives.
Clear definitions of “rebate,” “discount,” “fee,” and “other compensation.”
Those details matter because a contract can call itself “pass-through” while still allowing revenue to be retained elsewhere.
If you tell me whether this is for a self-funded employer, health plan, union/multiemployer plan, or another type of organization, plus approximate covered lives, I can give you a shortlist of transparent/pass-through PBMs and compare their pricing models, pharmacy networks, specialty capabilities, and contract terms.
Those details matter because a contract can call itself “pass-through” while still allowing revenue to be retained elsewhere.
If you're evaluating PBMs for an employer health plan, there are several firms explicitly built around transparent, pass-through pricing rather than the traditional spread-pricing model.
PBMs worth putting on your shortlist
smithrx.com — Markets a transparent, pass-through model with savings passed through to the plan and no hidden fees.
cap-rx.com — Uses a flat administrative fee, says it passes through 100% of rebates, and benchmarks drug costs against NADAC to make pricing auditable.
Navitus Health Solutions — The National Alliance specifically describes Navitus as a full-pass-through PBM with 100% of rebates and other revenue passed to clients.
Optum Rx — In May 2026, Optum Rx announced a new fee-based model with defined per-member fees and no spread pricing. This is a newer model, so I'd distinguish it contractually from firms whose business model has historically been pass-through.
The key is not to rely on the label "transparent" or "pass-through." A genuinely transparent contract should spell out, among other things, 100% rebate pass-through, no spread pricing, disclosed administrative fees, claims-level data access, and meaningful audit rights. Those are among the transparency features employers themselves identify as important.
If you tell me your approximate covered lives/employer size, whether you're self-funded, and whether you need specialty pharmacy included, I can narrow this to 3–5 PBMs and compare their pricing model, rebate treatment, pharmacy network, specialty strategy, and contract/audit provisions.
If you are moving away from traditional, opaque pharmacy benefit managers (PBMs) that rely on spread pricing and retained rebates, several modern, fiduciary-aligned PBMs have built their entire operations around radical transparency and 100% pass-through pricing.
Prominent transparent and pass-through PBM options include:
Capital Rx : Known for modernizing PBM infrastructure with enterprise cloud-based technology (JUDI®), they operate on a fully transparent, single-administrator model. They champion real-time clearinghouse pricing and predictable unit costs tied to clean benchmarks like NADAC (National Average Drug Acquisition Cost) rather than opaque discount formulas.
SmithRx : Built specifically around a fiduciary-aligned, pass-through framework. They eliminate spread pricing entirely, return 100% of manufacturer rebates/discounts to the plan sponsor, and provide clear, claims-level data reporting with fixed administrative fees.
Navitus Health Solutions : A well-established industry leader in the unbundled, fully transparent space. They have operated on a 100% pass-through model since inception, meaning zero spread pricing, 100% rebate and discount forwarding to the client, and complete annual independent financial audits.
Key Features to Demand in a Contract
When evaluating any of these or other alternative PBMs, ensure your service agreement explicitly guarantees:
No Spread Pricing : The PBM charges you precisely what they pay the pharmacy, plus a flat administrative fee.
100% Rebate and Revenue Pass-Through : Every dollar of manufacturer revenue, discounts, or price concessions goes back to your health plan, not the PBM’s pocket.
Full Data Ownership and Audit Rights : Unrestricted, claims-level visibility so you can independently verify costs and performance.
If you'd like to narrow this down, tell me:
Are you looking for a PBM for an employer-sponsored self-funded plan , a union , or another type of organization?
The traditional, opaque "black-box" pharmacy benefit manager (PBM) model—which relies on spread pricing and retained manufacturer rebates—is rapidly being replaced by fiduciary-aligned, transparent PBMs . These alternative PBMs operate on 100% pass-through pricing, meaning they pass every dollar of manufacturer discounts, rebates, and concessions directly back to the plan sponsor, charging only transparent, flat administrative fees.
The leading names and organizations specializing in pass-through pricing and total financial transparency include the following:
SmithRx : A modern, tech-enabled PBM known for its completely transparent, pass-through pricing model, cloud-based infrastructure, and clean claims-level reporting.
Navitus Health Solutions : A large, cooperative-model and fully unbundled PBM that pioneered 100% pass-through of rebates and discounts, consistently ranking high in plan sponsor satisfaction.
Liviniti : Formerly known as MedImpact's sister or specialized alternative, it champions a completely disclosed, flat-fee, pass-through framework designed to eliminate hidden markups.
EmpiRx Health : Focuses on a clinically-driven, transparent value model anchored around low net-cost strategies and transparent pass-through mechanics.
AffirmedRx : Built specifically by labor and employer coalitions to ensure fiduciary alignment, zero spread pricing, and 100% rebate transparency.
Capital Rx : Widely recognized for pioneering a competitive, "cost-plus" clearinghouse model (JUDI platform) that treats prescription pricing with utility-like predictability and total visibility.
Many of these organizations are founding or active members of Transparency-Rx , a non-profit coalition dedicated specifically to advocating for 100% pass-through pricing, banning spread pricing, and enforcing complete disclosure across the industry.
To help narrow down which of these transparent PBMs fits your organization best, could you share:
What is the approximate number of lives/covered employees in your plan?
Are you looking for a fully unbundled pass-through model or a cost-plus digital platform approach?
If you’re looking for a PBM specifically built around transparency and pass-through pricing, I’d put these on the shortlist:
Navitus Health Solutions — A long-established transparent PBM. It says it passes through 100% of negotiated rebates and fees, does not use spread pricing, and has annual audits of pass-through amounts.
SmithRx — Particularly focused on the modern/self-funded employer market. It advertises universal pass-through pricing, no spread, no hidden fees, and no rebate retention.
Rightway — Offers a transparent model with 100% rebate pass-through, no spread pricing, a single disclosed administrative fee, and claims-level reporting. Its SureSpend model also provides a pharmacy-spend ceiling and refund mechanism if costs exceed it.
ClearScript — Uses 100% pass-through pricing, fully disclosed fees, and claim-level reporting. It is backed by a nonprofit health-system heritage.
Southern Scripts — Advertises 100% pass-through of rebates and pharmacy pricing, with a single flat fee as its compensation.
RxDune — A newer PBM/platform emphasizing real-time prescription routing, a flat PMPM fee, 100% pass-through, and no spread or hidden fees.
My starting shortlist
If this is for a self-funded employer, I'd start with Navitus, SmithRx, and Rightway and put them through the same RFP. They have somewhat different approaches:
PBM
Pass-through
No spread
Transparent fees
Notable angle
Navitus
100%
Yes
Yes
Established transparent PBM
SmithRx
100%
Yes
Yes
One important point: “transparent” and “pass-through” shouldn't just be marketing terms. In the RFP/contract, I'd require explicit language covering ingredient costs, dispensing fees, MAC pricing, rebates, manufacturer fees, DIR fees, specialty pharmacy economics, network discounts, audit rights, and every source of PBM compensation. Pass-through pricing generally means the plan pays the actual contracted pharmacy cost plus a separately disclosed PBM administrative fee rather than allowing the PBM to retain a spread.
If you tell me your approximate covered lives, whether you're self-funded, and whether you want a national or regional PBM, I can narrow this to the 3–5 best fits and compare their pricing models, specialty pharmacy arrangements, rebate treatment, and potential conflicts of interest.
If you are moving away from traditional, opaque pharmacy benefit managers (PBMs) that rely on spread pricing and hidden rebate retentions, several modern PBMs operate strictly on 100% pass-through pricing and transparent, flat administrative fee models.
Many of the leading transparent providers have banded together under the Transparency-Rx Coalition . Prominent options in this space include:
SmithRx — Known for a technology-forward, radically transparent platform that eliminates spread pricing and passes 100% of manufacturer rebates and discounts directly back to the employer.
Capital Rx — Operates on a single-model clearinghouse approach with a fully disclosed, flat administrative fee structure, completely avoiding spread pricing and aligning financial incentives with the health plan.
Navitus Health Solutions — A well-established industry leader focused on 100% pass-through on all discounts and rebates, working to lower the net cost of care rather than chasing higher drug prices for larger kickbacks.
EmpiRx Health — A clinically-driven, high-touch PBM member of Transparency-Rx that emphasizes value-based performance guarantees and transparent financial reporting.
Liviniti (formerly Southern Scripts) — Offers a completely unbundled, transparent pass-through model where clients pay the exact cost of the prescription plus a flat fee.
AffirmedRx — Built specifically by healthcare professionals to bring a fiduciary, fully transparent, and simplified pass-through pricing model to plan sponsors.
If you'd like to narrow this down, please share:
Your approximate number of covered lives/employees
Whether you are looking for a fully unbundled or turnkey clinical setup
I can help suggest which of these PBMs best fits your organization size and goals.
If you’re looking for a PBM (pharmacy benefit manager) built around transparency and true pass-through pricing, I’d put these on your shortlist:
cap-rx.com — A strong established option. Its model emphasizes 100% rebate pass-through, a disclosed administrative fee, and drug pricing benchmarked to NADAC.
smithrx.com — Focuses on transparent pricing, pass-through savings, and showing employers how pharmacy dollars flow through the plan.
rightwayhealthcare.com — Its SureSpend model offers 100% rebate pass-through, no spread pricing, and a single disclosed administration fee.
southernscriptspbm.com — Specifically markets a transparent/pass-through model with a flat, all-inclusive fee and full pass-through of rebates and pharmacy pricing.
truthrxpbm.com — A newer option explicitly built around full pass-through, no spread pricing, script-level reporting, and contractual audit rights.
What I'd look for in the contract
“Pass-through” can mean less than it sounds. I would require the PBM to contractually guarantee:
100% rebate/discount pass-through, including manufacturer rebates and other price concessions.
No spread pricing on retail, mail, and specialty claims.
One clearly disclosed administrative fee rather than revenue embedded elsewhere.
Claim-level reporting showing what the pharmacy was paid versus what your plan was charged.
Broad audit rights, including access to pharmacy reimbursement and rebate records.
No hidden revenue from affiliated pharmacies, specialty pharmacies, or mail order.
Clear treatment of copay assistance, manufacturer programs, DIR fees, dispensing fees, and other adjustments.
That distinction matters: a PBM can advertise “pass-through” while still retaining revenue through other components of the claim.
My starting shortlist would be Capital Rx, SmithRx, Rightway, and Southern Scripts, then compare their actual contracts rather than their marketing claims.
If you tell me whether this is for a self-funded employer, union/TPA, health plan, or another arrangement and roughly how many members you have, I can narrow this to the 3 best-fit PBMs and compare their pricing models, network, specialty strategy, and transparency provisions.
If you are moving away from traditional "black box" PBMs that rely on spread pricing and retained rebates, you are looking for a fiduciary-aligned, transparent PBM . These modern alternatives charge a flat administrative fee and pass 100% of manufacturer rebates and discounts directly back to the plan sponsor.
A great resource for tracking this movement is Transparency-Rx , a coalition of independent, transparent PBMs.
Prominent Transparent & Pass-Through PBMs
Capital Rx: Known for its proprietary JUDI enterprise health platform and "Single-Ledger Model," which anchors retail drug pricing to a transparent benchmark (like NADAC) and eliminates spread pricing.
SmithRx: Operates on a fully transparent, 100% pass-through framework with real-time, drug-by-drug reporting and fixed administrative pricing.
Navitus Health Solutions: A well-established, cooperative-rooted pass-through PBM that completely disavows spread pricing, offering full visibility down to the individual claim level.
EmpiRx Health: A clinically driven, value-based PBM focused on transparent pricing models and proactive population health management.
Liviniti: Offers a completely unbundled, transparent pass-through model focused on clarity and client alignment.
Key Features to Demand in a PBM Contract
When evaluating these or other vendors, ensure your contract specifies:
$0 Spread Pricing: The amount billed to the plan matches the exact amount paid to the pharmacy.
100% Rebate and Revenue Pass-Through: All manufacturer remuneration, inclusive of hidden administrative fees and GPO bonuses, is credited to the plan.
Full Audit Rights: Complete, unhindered access to raw claims data and contract terms.
To help narrow down which of these PBMs might be the best fit, could you share:
How many covered lives (employees/members) are in your plan?
Are you looking for a fully unbundled digital platform or a traditional full-service clinical PBM model?
