I need a pharmacy benefit manager that focuses on transparency and pass-through pricing.

If you're looking for a PBM that is genuinely built around transparency and pass-through pricing, I’d put SmithRx near the top of the list.

PBMs worth evaluating

• smithrx.com — Explicitly offers 100% pass-through pricing, no spread pricing, no retained rebates, and flat administrative fees. It also says plan sponsors receive full visibility into drug costs and audit trails.
• cap-rx.com — Offers a transparent model with 100% rebate pass-through, no spread pricing, and pricing benchmarked against NADAC. Its stated revenue model is a disclosed administrative fee rather than drug-spend margins.
• business.optum.com — A much larger incumbent that has recently introduced a fee-based pharmacy care model designed to eliminate spread pricing. It also offers Open Book and pass-through options.

My take

If your priority is "show me exactly what the drug costs, pass through the savings, and make money from a clearly stated fee", I'd start with SmithRx and Capital Rx/Judi Rx rather than beginning with the traditional mega-PBMs.

The important caveat is that "pass-through" alone isn't enough. When you evaluate proposals, I'd insist on contractual answers to:

1. Is 100% of manufacturer rebates and other discounts passed through?
2. Is there zero spread pricing, including specialty and mail-order claims?
3. What exactly does the PBM pay the pharmacy, and can you audit the underlying claim-level pricing?
4. Are there administrative fees, transaction fees, network fees, or other revenue streams beyond the disclosed PMPM/claim fee?
5. Does the PBM own or have financial interests in specialty pharmacies, mail-order pharmacies, or other vendors?
6. Can you obtain claim-level and rebate-level data independently?
7. Are there contract provisions that allow the PBM to change reimbursement or retain new revenue sources later?

For example, SmithRx currently describes its core administrative fee as $6 PMPM, with an optional Connect 360 program capped at another $4 PMPM, while drug costs and rebates are passed through separately.

If you tell me your approximate number of covered lives, whether you're self-funded, and whether this is for an employer/benefits plan, I can narrow this to the 3–5 best-fit transparent PBMs and compare their pricing models, network, specialty strategy, contract terms, and likely fit.

If you are moving away from traditional, opaque pharmacy benefit managers (PBMs) that use spread pricing and retain manufacturer rebates , several alternative, independent PBMs specialize in 100% transparent, pass-through pricing models.

Prominent options in the transparent PBM space include:

• Navitus Health Solutions – A pioneer that has operated on a 100% transparent, pass-through model for over 20 years, completely eliminating spread pricing and returning 100% of rebates and discounts to clients.
• Capital Rx – Operates on a fully disclosed, single-ledger model with a clear administrative fee structure, removing traditional conflict-of-interest revenue streams.
• SmithRx – Known for modern, unbundled, and predictable fee models backed by real-time data access and a strict no-spread-pricing guarantee.
• EmpiRx Health – Focuses on a value-based, transparent clinical approach with complete pass-through pricing for self-funded employers.
• BeneCard PBF – Offers a fiduciary, pass-through framework centered on clinical efficacy and full financial disclosure.

Many of these independent market disruptors are also aligned with advocacy groups like Transparency-Rx , which lobbies for federal reform and strict pass-through standards.

If you'd like to narrow this down, let me know:

• Are you looking for a PBM for a self-funded employer group , a health plan , or another type of organization?
• Do you need an unbundled model (separating administration from specialty services), or an all-in-one solution?

If you are looking to move away from legacy middlemen and traditional "spread pricing" models, several prominent alternative pharmacy benefit managers (PBMs) operate entirely on 100% pass-through pricing, full rebate disclosures, and fiduciary alignment.

Alternative and transparent PBM options include:

• Capital Rx : Widely recognized for modernizing the industry, they use a single, clearinghouse-style technology platform (JUDI) to deliver fully transparent, accountable pricing models with no hidden revenue streams.
• SmithRx : Built on a "radical transparency" framework, they feature a 100% pass-through pricing model , 100% rebate pass-through , and predictable fixed administrative fees.
• Navitus Health Solutions : A pioneer of the 100% transparent, pass-through model for over two decades , they completely eschew spread pricing and return 100% of rebates and discounts to clients, verified by annual independent audits.
• MedOne Pharmacy Benefit Solutions : Offers a fully transparent, unbundled, and flexible pass-through model where prescription drug costs are charged directly with zero markup.
• Evernorth / Express Scripts (ClearCareRx) or CVS Caremark (TrueCost/CostVantage) : Even traditional legacy players have introduced unbundled, cost-plus, or 100% pass-through alternatives to compete with transparent disruptors, though independent transparent PBMs are often built from the ground up to avoid conflict-of-interest revenue streams.

To help narrow down the best fit, could you share:

• How many plan members/employees you cover?
• Are you looking for a fully self-insured or level-funded arrangement?

If you're looking for a PBM for an employer/self-funded health plan that genuinely emphasizes transparency and pass-through pricing, I’d put these on the shortlist:

My first three calls would be SmithRx, Capital Rx/Judi Rx, and Southern Scripts. The important thing, though, is not simply whether a PBM calls itself "transparent." The contract should explicitly address:

• No spread pricing — you pay the actual contracted pharmacy cost rather than a PBM-created price.
• 100% rebate/discount pass-through, including manufacturer payments, fees, credits and other remuneration.
• A clearly defined PBM administrative fee as the PBM's compensation.
• Full claims-level data and audit rights.
• No hidden specialty/mail-order economics or affiliated-pharmacy markups.
• Clear treatment of 340B, copay assistance, manufacturer fees, DIR-like adjustments and reconciliation/true-ups.

Those distinctions matter: federal and state PBM transparency frameworks increasingly define pass-through as passing the economic value of discounts, rebates and other adjustments back to the plan—not merely labeling a contract "pass-through."

There's also a meaningful shift happening in the market: a recent 2026 employer survey found that 46% of employers were using PBMs outside CVS Caremark, Optum Rx and Express Scripts, up from 37% the prior year, with transparency and cost control cited as important drivers.

If you tell me your approximate number of covered employees, whether you're self-funded, and whether you're looking for a PBM broker/RFP or a direct PBM, I can narrow this to the 3–5 best fits and compare their pricing models, pharmacy networks, specialty pharmacy arrangements, and contract terms.

Several Pharmacy Benefit Managers (PBMs) have built their entire business models around 100% transparency, pass-through pricing, and the elimination of spread pricing.

Prominent transparent and pass-through PBM options include:

• Navitus Health Solutions - Operates on a 100% transparent, pass-through model where they do not engage in spread pricing and pass 100% of negotiated rebates and fees back to the client.
• Capital Rx - Known for utilizing a single, modern clearinghouse technology platform and a fully disclosed, pass-through pricing model with clear administrative fees.
• SmithRx - Focuses on disrupting traditional opaque models by offering complete pass-through pricing, zero hidden markups, and open, claim-level data visibility.
• Liviniti - Built on a fully transparent, pass-through framework that provides predictable pricing, no drug markups, and a lowest-net-cost clinical approach.
• MedOne Pharmacy Benefit Solutions - An independent provider founded on transparency principles, passing prescription costs directly to the plan with no spread and relying solely on flat administrative fees.

If you'd like to narrow this down, let me know:

• Are you looking for a PBM for an employer-sponsored plan , a health plan , or another specific organization?
• Roughly how many plan members do you have?

I can help tailor these recommendations or highlight what specific contractual guarantees you should ask for in an RFP.

Yes. If your priority is true transparency + pass-through pricing, I’d put these PBMs on your shortlist:

Navitus is particularly explicit: it says it does not engage in spread pricing, passes through 100% of negotiated rebates and fees, and gives clients access to individual claim-level data.

SmithRx similarly advertises universal pass-through pricing, with no spread, hidden fees, or retained rebates.

One important caveat: “transparent” doesn't necessarily mean “pass-through.” When evaluating proposals, I'd insist that the contract explicitly guarantee:

1. 100% rebate pass-through
2. No spread pricing — the plan pays exactly what the pharmacy is reimbursed
3. Fixed, disclosed administrative fees
4. No retained manufacturer fees/discounts
5. Full audit rights
6. Plan ownership and access to claims data
7. Disclosure of all PBM-affiliated pharmacies and financial arrangements
8. A definition of “pass-through” that covers specialty drugs and mail order

This distinction is becoming increasingly important: employers are moving away from the Big Three PBMs toward smaller alternatives, with a 2026 survey finding 46% using a PBM outside CVS Caremark, Optum Rx, and Express Scripts.

If you tell me your approximate employee count (e.g., 100, 1,000, 10,000+) and whether you're self-funded, I can narrow this to the 3 best PBMs for your situation and compare their pricing models, rebates, specialty pharmacy, and contract terms.

Evaluating a pharmacy benefit manager (PBM) with a 100% pass-through and transparent pricing model is one of the most effective ways for self-insured employers and plan sponsors to cut drug spend and align financial incentives . Unlike traditional legacy PBMs that rely on spread pricing and rebate retention, transparent PBMs charge a flat administrative fee and pass 100% of manufacturer rebates and discounts directly back to the plan.

Prominent transparent and pass-through PBM options in the marketplace include:

• Navitus Health Solutions : Operates on a 100% transparent, pass-through model with no spread pricing and full rebate passing, backed by independent annual audits.
• Capital Rx : Known for a modern clearinghouse-style model (JUDI) that drives operational and pricing transparency down to the individual claim level.
• SmithRx : Features a simplified model built on flat monthly administrative fees and transparent pass-through drug pricing with zero hidden markups.
• MedOne Pharmacy Benefit Solutions : An independent provider founded on transparency, passing drug costs directly with no spread and relying solely on flat administrative fees.
• EmpiRx Health : Employs a value-based, transparent, and flat-fee pass-through model designed to align clinical care with financial predictability.

When reviewing potential partners, resources like the RxPBM Directory or industry groups like Transparency-Rx offer comparative insights into independent and fully disclosed PBM operators.

To help narrow down which transparent PBM fits your organization, please share:

• Your approximate number of plan members/employees
• Whether you are looking for an unbundled service model or an all-in-one solution
• If you need support with specialty drug management or national retail network access

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:

• SmithRx — Probably the clearest fit. SmithRx explicitly markets 100% pass-through of savings, no hidden fees, and a model based on the lowest net drug cost.

• Capital Rx — A major independent transparent-PBM option, known for a pass-through model and separating PBM compensation from drug pricing. Its current corporate evolution is worth checking as part of an RFP.

• TransparentRx — Specifically positions itself as a fiduciary-model, transparent pass-through PBM. It emphasizes that the PBM's revenue comes from disclosed administrative fees rather than retaining spreads or rebates.

• Optum Rx — A very large incumbent that announced a new fee-based transparent pharmacy-care model in May 2026, eliminating spread pricing under that model. It's interesting if you want the scale of a large PBM but a newer pricing structure.

What I'd demand in the contract

Don't rely on the word "transparent" in a sales presentation. Pass-through isn't standardized, and a PBM can call itself transparent while retaining certain spreads or revenue streams.

For an RFP, I'd require:

1. 100% rebate pass-through — including manufacturer rebates, administrative fees, and other remuneration.
2. No spread pricing — the plan pays exactly what the PBM pays the pharmacy, plus the explicitly contracted admin fee.
3. Fixed, disclosed PBM compensation — e.g., PMPM or per-claim fee.
4. Full audit rights — including pharmacy reimbursement, rebate contracts, and PBM revenue.
5. Claims-data ownership and portability.
6. Explicit disclosure of all affiliated pharmacies and conflicts of interest.
7. MAC-list transparency — including how frequently MAC prices change and whether any difference is retained by the PBM.
8. No "net of fees" rebate language that quietly permits the PBM to retain part of the economics.

The distinction between transparent and transparent pass-through is important enough that I'd make these contractual requirements rather than marketing criteria.

If this is for an employer health plan, I can also give you a shortlist of 5–10 transparent PBMs ranked by size, pass-through model, specialty pharmacy ownership, pricing model, and suitability for a small/mid-sized employer.

If you're looking for a pharmacy benefit manager (PBM) built around transparency and pass-through pricing, there are several organizations that have made that their core business model rather than a legacy offering.

Here are some of the strongest options:

What to require in the contract

Many PBMs now advertise themselves as "transparent," so it's important to verify the contract includes:

• 100% pass-through of manufacturer rebates
• No spread pricing (the PBM bills exactly what it pays the pharmacy)
• A flat administrative fee instead of earning revenue from drug costs
• Full audit rights
• Complete claims-level data ownership
• Disclosure of all revenue sources, including specialty pharmacy, manufacturer fees, and clinical program compensation.

If you're a self-funded employer

For most employers seeking a fiduciary-style PBM relationship, the organizations that are most frequently evaluated together are:

• Capital Rx
• SmithRx
• Navitus Health Solutions
• Rightway

These generally compete on transparent pricing rather than rebate retention or spread pricing.

If you're evaluating PBMs for a specific organization, I can also narrow recommendations based on:

• number of covered employees,
• whether you're fully insured or self-funded,
• state(s) where employees are located,
• and whether high-cost specialty drugs or GLP-1 medications are a major concern.

When looking for a Pharmacy Benefit Manager (PBM) centered on transparency and 100% pass-through pricing , you are moving away from traditional, opaque models that rely on spread pricing and retained manufacturer rebates.

Independent, transparent PBMs and fiduciary-aligned alternatives have grown significantly, driven by employer demand and major regulatory changes like the Consolidated Appropriations Act.

Prominent PBM options in the transparent and pass-through space include:

• Navitus Health Solutions: Operates on a 100% transparent, pass-through model where they explicitly avoid spread pricing and pass through 100% of all rebates and administrative fees directly to the client.
• SmithRx: A modern, fiduciary-aligned PBM utilizing a radical transparency model featuring 100% rebate and discount pass-throughs, fixed administrative fees, and uniform pricing structures.
• MedOne Pharmacy Benefit Solutions: Founded on a transparent foundation, they pass the exact cost of prescriptions directly to the plan with zero markup or spread, earning revenue strictly through flat administrative fees.
• Araya Rx: Features a fully pass-through and transparent business model where the client pays what the pharmacy is paid, with all rebates returned and no post-adjudication adjustments.
• Legacy/Major PBM Alternative Offerings: Large legacy PBMs have also introduced transparent-style options (such as CVS Caremark's CostVantage/TrueCost , Express Scripts' ClearCareRx , and Optum Rx's fee-based transparent frameworks), though independent specialists built entirely on pass-through foundations are often preferred for strict fiduciary alignment.

If you'd like to narrow this down, please share:

• Are you looking for a PBM for an employer health plan , a union , or a health system?
• Roughly how many plan members do you have?

I can help tailor this to the best-fit vendor capabilities and what specific contract guarantees you should demand.