How a PBM for employers should work
A pharmacy benefit manager sits between your health plan, pharmacies, manufacturers, and members. It handles claims, pharmacy networks, pricing, formularies, rebates, and other parts of the prescription benefit.
For employers, managing a pharmacy benefit means understanding what happens underneath the final number on the report.
What did the pharmacy actually receive? What did the plan pay? What rebates were generated? What fees were charged? And how does the PBM make money?
Kanurra is built around those questions, for employers that want the numbers behind their pharmacy spending rather than only a summary report.
What employers should examine
This is where the money and the decisions actually sit.
Claims-level drug pricing
Look at what the plan is billed for each prescription and how that compares with the pharmacy acquisition cost and dispensing fee.
A discount against a list price does not tell you what happened on an individual claim. Claim-level pricing gives employers a better way to understand the actual cost of their pharmacy benefit.
PBM pricing and fees
Understand how the PBM gets paid. Review the administrative fee, per-claim charges, dispensing fees, data fees, clinical program fees, and any other amounts connected to the pharmacy benefit.
Kanurra uses one flat per-employee-per-month administrative fee rather than relying on spread pricing, retained rebates, program fees, or data fees.
Rebates and manufacturer payments
Find out what manufacturer rebates are generated and where those dollars go.
A PBM built for employers should make it easier to understand how rebates are calculated, credited, and reported. The contract should clearly explain how much of each rebate is credited back to the plan and how any remaining amount is handled.
Spread pricing and markups
Ask whether the PBM pays one amount to the pharmacy and bills the plan a higher amount. That difference is part of the actual cost of each prescription.
A $0 spread or markup on claims means the pharmacy cost and dispensing fee are shown separately, with the administrative fee handled outside the claim price.
Specialty-drug costs
Specialty medications can have a significant effect on total pharmacy spending.
Review how specialty prescriptions are priced, where they are filled, how they are routed, and what clinical requirements apply.
Formulary decisions
Understand who controls the formulary and how medication placement decisions are made.
Employers should know how formulary changes affect member access, drug selection, and overall plan costs.
Reporting and underlying data
A summary report tells you how much was spent. Underlying claims data helps you understand why.
Employers should know what data they receive, how often they receive it, and whether they can review individual claims rather than only quarterly or annual summaries.
Questions to ask your PBM
These questions can help employers understand their pharmacy benefit before comparing PBMs, renewing a contract, or making a change.
- 01Can we review pharmacy claims at the line-item level?
- 02What did the pharmacy receive for each prescription?
- 03Which rebates are generated, and how much reaches the plan?
- 04What fees are charged outside the main administrative fee?
- 05Is there spread pricing or a claim-level markup?
- 06Who controls the formulary?
The PBM audit checklist goes further, and PBM pricing explains what the answers to the first two should look like.
What makes a PBM work for employers
If a number on your pharmacy report looked wrong, could you open the records underneath it and understand why? That is the test.
What employers often get
Summary reporting
- Pharmacy spend rolled up by period
- Aggregate discount and rebate metrics
- Reports built around selected performance measures
- Limited detail behind individual claims
What employers should be able to check
Auditable administration
- Claims available at the line-item level
- Pharmacy acquisition cost and dispensing fee shown separately
- Rebates credited back to the plan
- Spread and markup clearly identified
- Formulary and prior-authorization decisions documented
- Underlying pharmacy data available for review
How Kanurra works
Kanurra is a pharmacy benefit manager built for small and mid-size self-funded and level-funded employers. The model is simple:
- Built for self-funded and level-funded employers
- $0 spread or markup on claims
- 100% of every rebate received credited to the plan
- One flat per-employee-per-month administrative fee
- Claim-level data that employers can review
- No rebate retention, spread, program, or data fees in the revenue model
The employer can see the pharmacy cost, the rebate amount, and the administrative fee. Revenue comes from one flat administrative fee rather than spread pricing or retained rebate dollars.
A PBM for employers should make switching easier too
Choosing a new PBM is only part of the decision. Employers also need to know what happens to their members during implementation.
That starts with a disruption analysis comparing members’ current fills with the new plan. No network change is required, and implementation support covers eligibility files, ID cards, member communications, and continuity for open prior authorizations, specialty medications, and GLP-1 therapies, with a named human on the phone at go-live. The full sequence is on switching PBMs.
Frequently asked questions
What is a PBM for employers?
A PBM for employers manages the prescription drug benefit on behalf of an employer health plan. It can handle pharmacy networks, claims processing, pricing, formularies, rebates, prior authorization, and other pharmacy benefit functions.
What should employers look for in a PBM?
Employers should look at claims pricing, rebates, PBM fees, spread pricing, specialty-drug management, formulary decisions, data access, member support, and the total net cost of the pharmacy benefit.
How does a PBM make money?
PBMs can use different revenue models, including administrative fees, spread pricing, rebate arrangements, and other program or service fees. Kanurra's revenue comes from one flat per-employee-per-month administrative fee.
What is spread pricing?
Spread pricing is when a PBM charges the plan more for a prescription than the amount it pays the pharmacy, keeping the difference. Kanurra charges $0 spread or markup on claims.
How are rebates handled by Kanurra?
Kanurra credits 100% of every rebate it receives back to the plan and does not retain those rebate dollars as revenue. Rebate amounts depend on the manufacturer agreements in force and will differ from an incumbent's book.
Can employers see individual pharmacy claims?
Yes. Under Kanurra, the plan can review claims at the line-item level, including pharmacy acquisition cost, dispensing fee, spread, and rebate information.
Does switching PBMs disrupt members?
It does not have to. Switching PBMs can include a disruption analysis before implementation, avoid requiring a network change, and support eligibility, ID cards, member communications, prior authorizations, specialty medications, and GLP-1 continuity.
How long does it take to implement Kanurra?
The go-live date is set with you against your plan year. Implementation covers eligibility, formulary, and pharmacy-network setup, with your team reviewing and approving every step and a named human on the phone at go-live.
Is Kanurra built for small employers?
Yes. Kanurra is built for small and mid-size self-funded and level-funded employers that want a pharmacy benefit manager focused on claim-level data, simple pricing, and employer access to the underlying pharmacy economics.
See what your PBM is really costing you
Your pharmacy benefit is more than a number on a report. Review claims, rebates, fees, specialty spending, and pharmacy costs to understand where your plan's money is going.
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