Who your employer pays for pharmacy

An employer that runs its own health plan files a Form 5500 every year and lists the service providers it paid on Schedule C. Naming the pharmacy benefit manager is not optional in spirit, but in practice it is. Of the 8,522 self-funded employers large enough to matter, 7,946 filed without identifying who administers their drug benefit or what that costs.

This is the same opacity Analysis 001 found at the plan level, measured a different way. There, only about 2% of self-funded plans disclosed enough to tell whether one parent sat on both sides. Here, among employers with at least a thousand people, fewer than 7% name the PBM at all.

The disclosed amounts are extremely uneven. Half the employers that report a fee disclose under $47 per employee a year. A quarter report under $19. A quarter report over $155. Within any single PBM, two filings can be most of the total.

That matters because the obvious comparison is wrong. Ranked by total fees divided by total employees, Optum Rx looks roughly four times more expensive than Express Scripts. Ranked by the median filing, the order reverses. The aggregate is not measuring price; it is measuring which large employers happened to file a large number.

So the table below shows both, side by side, with the share of each total that comes from just two filings. Read the median. Treat the aggregate as a warning about the data rather than a fact about the PBM.

Metros where at least one large self-funded employer names its PBM. "Employers of 1,000+" counts every such plan filed in the metro, disclosed or not, so the two columns together show the local disclosure rate. Search to find a city.

Every self-funded employer of 1,000 or more people that named a PBM for plan year 2024, one row per filing. A few employers file more than one plan, so the 576 filings come from about 569 employers. Search by employer, PBM, state or metro. Click a column to sort. "PDF" opens the signed Form 5500 filing.

Source: Form 5500 annual filings from the Department of Labor's EFAST2 system, plan year 2024, all industries. Schedule C names each plan's paid service providers and their compensation. Every figure on this page is pulled from the public Verzi Health data API, endpoints /rx/employers and /rx/employers/metros, so the page and the API always agree. The API needs a free key; the CSV and JSON on this page need none.

Scope: plans whose welfare codes include 4A, whose funding class is self-funded, with 1,000 or more active participants. A plan counts as naming a PBM when a pharmacy benefit manager appears among its Schedule C service providers.

What this can and cannot say. Compensation is the direct compensation disclosed on Schedule C. It is a fee paid to the PBM, not drug spend, and not the price of any drug. Employers report it inconsistently: some disclose a full administrative fee, others a fraction, others nothing while still naming the provider, which is why the distribution is so wide and why no aggregate on this page should be read as a price. Participant counts are active participants on the Form 5500. Metro comes from the sponsor's filing address, so a company headquartered in one city and operating in another appears under its headquarters. Plans below 100 participants generally do not file. Twenty-three filings named a PBM but disclosed $0; they count in the 576 as naming a PBM, but they are left out of the medians, quartiles and per-PBM fee figures, because a reported $0 means the amount was not disclosed rather than that the service was free. Counts are of health-plan filings: a few employers file more than one plan, so the 576 and the 8,522 are filings on the same basis. The metro table covers only self-funded plans of 1,000 or more, the same universe as the rest of the page. The 576 are those that disclosed; nothing here describes the 7,946 that did not, and there is no reason to assume they resemble each other.