How Being a Public Benefit Corporation Drives Real Change in Pharmacy Benefits
Pharmacy Benefit Managers (PBMs) have long been both the gatekeepers and the disruptors of America’s prescription drug system. Positioned at the crossroads of insurers, drug manufacturers and pharmacies, their influence has shaped how patients access and afford life-saving medications. Yet, this power has too often been without transparency, fueling rising costs and eroding trust.
AffirmedRx is leading the change to transform this system. As a PBM structured as a Public Benefit Corporation (PBC), we are driving change within the industry. It’s more than a different model; it’s a commitment to a higher standard – one that prioritizes social and environmental impact over unchecked profit.
By designating ourselves as a PBC, we deliver unmatched accountability, ensuring every decision we make is driven by a mission to improve patient outcomes, enhance the pharmacy experience and reestablish trust in healthcare.
What is a Public Benefit Corporation?
A Public Benefit Corporation (PBC) is a legal structure that allows for-profit companies to prioritize social or environmental goals while still aiming to generate enough profits to stay in business. Unlike traditional for-profit corporations, which are legally bound to maximize shareholder value, a PBC must balance the financial interests of stakeholders with a commitment to a broader societal or environmental mission. This legal framework ensures that the company’s social impact is embedded in its operations, often requiring transparency around progress toward its public benefit goals.
By choosing this business model, AffirmedRx is legally bound to demonstrate accountability and make a positive difference in the world. The structure aligns our corporate goals with the public good, which is a major departure from the traditional PBM business model that often focuses solely on profits at the expense of other values. The bottom line is this: being a PBC requires AffirmedRx to demonstrate how our operations drive meaningful improvements in the lives of the patients we serve.
Why is This Revolutionary for PBMs?
AffirmedRx’s decision to be structured as a Public Benefit Corporation fundamentally changes how prescription drug management operates. Traditional PBMs have long been criticized for their lack of transparency and focus on profits, often at the expense of consumers. They negotiate rebates and discounts from drug manufacturers, but these rebates don’t always result in lower prices for consumers. Instead, PBMs have been accused of prioritizing their own financial gains over the best interests of patients and healthcare systems.
By operating as a Public Benefit Corporation, AffirmedRx is committed to serving the public good. We aim to build sustainable systems that prioritize patient welfare and reduce healthcare disparities. Here’s how our PBC structure empowers us to lead with purpose and deliver real change:
1. Focus on Patient-Centered Care
A PBC, on the other hand, is legally required to prioritize its social mission. This includes improving healthcare outcomes, enhancing patient access to medications and reducing costs for consumers. By putting patient welfare at the center of our operations, AffirmedRx is striving to make healthcare more equitable and affordable for everyone, not just the highest bidders.
AffirmedRx’s Patient Care Advocate (PCA) model is a testament to our commitment to improving healthcare outcomes. This model blends cutting-edge technology with a human touch and allows for real-time proactive pharmacy benefits management. For example, one of our members with schizophrenia was three weeks overdue for his medication, and facing barriers to access due to a new prescriber, benefit modifications and a prior authorization denial. The situation was urgent, so a PCA reached out to the patient’s provider and a same-day resolution was achieved through swift decision-making and problem-solving by conducting an investigation and verification of benefits for the patient. The PCA implemented an override for approval and facilitated seamless coordination with the pharmacy and the medical office to arrange for same-day delivery/administration. Within hours, the member received his vital medication, which alleviated his distress and ensured continuity of care.
2. Transparency and Accountability
By structuring as a Public Benefit Corporation, AffirmedRx leads with transparency. PBCs are legally required to disclose how they are achieving their public benefit goals, which can include pricing transparency, reductions in prescription drug costs and improved access to necessary medications. The transparency required of a PBC ensures that all stakeholders—patients, providers, insurers and shareholders—can see the full picture and know how our work affects patients’ ability to access their vital medications and have a clear understanding of where dollars are being spent and why.
3. Creating Long-Term, Sustainable Solutions
Unlike traditional PBMs that often chase short-term profits, AffirmedRx is built with a long-term vision. As a PBC, our goal is to improve the overall healthcare landscape for the future, which can include initiatives like increasing the availability of generic drugs, promoting the use of cost-effective medications and investing in prevention programs. These long-term commitments are more sustainable and focus on reducing the root causes of high healthcare costs rather than just treating the symptoms.
4. Improved Access to Medications
Structuring as a Public Benefit Corporation allows AffirmedRx to focus on improving access to medications for underserved populations, especially in rural or low-income areas where pharmacies and healthcare providers are limited. Traditional PBMs have sometimes been criticized for creating barriers to medication access through restrictive formularies or complex prior authorization requirements. However, structuring as a PBC requires us to prioritize ensuring essential medications are available to those who need them most, regardless of income or geographic location. When medications become more affordable and accessible, patient adherence to treatment improves, which leads to improvement in overall health outcomes.
The Future of PBMs
AffirmedRx’s decision to be structured as a Public Benefit Corporation sets a new standard in healthcare. We are committed to social impact, transparency and sustainability and believe this provides a much-needed alternative to traditional PBMs that have been criticized for prioritizing profits over patient welfare. By focusing on public benefit alongside financial success, we are reshaping the approach to prescription drug management, making healthcare more accessible, affordable and patient-centric.
This shift represents a move toward a more ethical and socially responsible healthcare system—one where businesses can profit while still making a meaningful impact on society. AffirmedRx envisions this revolutionary restructuring will impact the industry as a whole, pushing PBMs to become more transparent, accountable, and focused on improving patient care. The future of PBMs is not just about profits; it must be about making a real difference in people’s lives.
