Hospice organizations are trusted with delivering compassionate care during one of the most sensitive times in a patient's life. That care hinges on timely, affordable, and accessible medication. Yet, when hospices partner with a pharmacy benefit manager (PBM) that owns its own pharmacies, they may unknowingly be compromising those very standards of care.
While PBMs promise convenience and cost savings, their business model often presents serious drawbacks for hospice providers, especially when the PBM also acts as the pharmacy. Below are key reasons why this arrangement should raise red flags.
Conflicts of Interest Reduce Patient-Centered Care
When a PBM owns the pharmacy, it is incentivized to route prescriptions through its own dispensing network. This creates a clear conflict of interest: instead of acting as a neutral intermediary working on behalf of the hospice, the PBM becomes a competitor to the very pharmacies it’s supposed to support.
This means hospices might find themselves locked into a limited system that prioritizes PBM profits over patient care. Medications may be chosen based on margins rather than efficacy or availability, and options for patients become constrained as a result.
Reduced Pharmacy Choice and Competition
An open pharmacy network gives hospices the ability to choose from multiple local and national pharmacies to meet patient needs. But when a PBM funnels prescriptions into its own pharmacy system, it undercuts independent and retail pharmacy options.
This loss of competition can lead to:
- Delays in access when PBM-owned pharmacies lack the inventory or infrastructure of local providers.
- Frustrations for families and caregivers who prefer to use known or nearby pharmacies.
- Missed opportunities to partner with community pharmacies that understand the local landscape and patient preferences.
Hidden Costs and Lack of Pricing Transparency
One of the biggest concerns with PBM-owned pharmacies is a lack of clarity in how medications are priced. When the PBM sets the pricing, manages the benefit, and dispenses the drugs—all behind the scenes—there’s little visibility into what hospices are truly paying.
This opaque structure can result in inflated medication and dispensing fees, markups that are difficult to audit or dispute and limited ability to shop for competitive pricing across pharmacies. Hospices trying to control costs are left without the data or leverage needed to make informed decisions.
Geographic Gaps in Coverage
Hospice care happens everywhere from urban centers to rural communities. But PBM-owned pharmacies may not have the reach or distribution network to deliver timely medications in every area.
This creates a serious problem: patients can’t wait days for medication. If a PBM-owned pharmacy can’t fulfill an order promptly, it may delay symptom management and reduce quality of life in a critical time.
An open pharmacy model allows hospices to choose the most convenient and responsive pharmacy for each patient, regardless of location.
Extra Administrative Burdens for Staff
PBMs are notorious for adding more work on hospice clinicians and care teams through rigid formulary approval processes, complicated ordering systems, and lack of real-time order status tracking.
This increases staff workload and takes time away from patient care. Instead of streamlining operations, these PBM systems can actually create more friction and inefficiency.
A Better Path: Open Networks and Transparent Technology
Rather than working with a PBM that owns its own pharmacies, hospices can benefit more from a solution that separates technology from dispensing. BetterRX offers exactly that: a hospice-first medication management platform that supports an open network of retail, mail-order, and specialty pharmacies.
This approach allows for:
- Transparent pricing and real-time insights.
- Flexibility in pharmacy choice based on geography, cost, or availability.
- Faster turnaround times for orders.
- Reduced administrative burden on clinicians and care teams.
Hospices need a partner that prioritizes care, not one that profits from controlling every aspect of the process.
Choose Alignment Over Control
The goal of every hospice is to provide dignified, comfortable care for patients and their families. That mission should never be compromised by business models that create misaligned incentives.
By avoiding PBMs with owned pharmacies and instead partnering with technology solutions that emphasize transparency, choice, and patient-centric care, hospices can maintain control, reduce costs, and ensure they’re doing what’s best for the people they serve.
BetterRX was built for hospice—and only hospice. Contact us today to learn how our open network and easy-to-use platform help hospices put patients first.
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