Everything old, it seems, becomes new again, and so it is with health plans and their renewed interest in unbundling their Pharmacy Benefit Manager (PBM) relationships.

This trend first emerged in the early 2000s as payers began building their own pharmacy networks, contracting with manufacturers directly for rebates, and forging separate relationships with claims processors. In response, PBMs further incentivized, offering deeper discounts to payer partners to sustain or grow their prominence. Sure enough, in a few years, the pendulum swung back toward full-service PBM offerings and away from disintermediation.