Resource explains how retrospective discounts can drive uncertainty in pharmacy spend
and offers practical steps purchasers can take now
WASHINGTON – June 3, 2026 – The National Alliance of Healthcare Purchaser Coalitions (National Alliance) today released a new resource to help employers and other healthcare purchasers address a growing problem in pharmacy benefits: retrospective pricing arrangements that can obscure the true net cost of prescription drugs, increase financial volatility, and shift risk onto plan sponsors.
Rebates, guarantees, and reconciliation processes are often described as cost-saving tools. In practice, they can delay visibility into what employers actually paid for prescription drugs until months after claims are processed – making costs harder to predict, budgets harder to manage, and accountability harder to enforce.
The resource provides employers and purchasers with:
- A plain-language overview of how retrospective pricing works in many pharmacy benefit manager (PBM) contracts and where risk accumulates.
- A summary of common risk areas – including timing risk, cost volatility, and data gaps – that can materially impact employer-sponsored plans.
- Action steps and sample questions purchasers can use to strengthen contract terms, shorten reconciliation timelines, improve audit rights, and focus on net outcomes.
- Guidance to support benefit leaders preparing for contract renewals and evaluating alternative pricing approaches.
“Employers should not have to manage their pharmacy benefit in the dark or wait months to learn what they actually paid,” said Shawn Gremminger, president and CEO of the National Alliance. “When the true net price is determined through opaque, retrospective calculations controlled by others, purchasers are left with uncertainty, weaker accountability, and delayed value. This guide gives benefit leaders practical steps for the contract table to demand greater transparency, stronger contract terms, and more predictable pharmacy spending.”
This summary resource, How Retrospective Discounts Increase Risk and Costs, also links to a comprehensive report commissioned by the National Alliance, with research and writing from 3 Axis Advisors that examines the systemic financial risk embedded in retrospective pricing and rebate guarantees that dominate PBM contracts across commercial, Medicare, and Medicaid markets.
To help purchasers take action, the National Alliance will host a complimentary webinar, The Hidden Cost of PBM Rebates: How Retrospective Pricing Shifts Risk to Employers, at 2:00 pm Eastern on Wednesday, June 17. Learn more and register.
About National Alliance of Healthcare Purchaser Coalitions
For more than 30 years, the National Alliance has brought together business coalitions and their employer and purchaser members to drive high-quality healthcare that enhances patient experience, promotes health equity, and improves outcomes while lowering costs. Its members represent public and private sectors, nonprofits, and labor unions that provide health benefits to over 90 million Americans—more than half of the employer-sponsored insurance market—spending over $850 billion annually. To learn more, visit nationalalliancehealth.org and connect on LinkedIn.
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