Paul H. Flowers Jr.Senior Business Consultant, Superior Insurance Advisors, LLC · 2024 Hot 100 honoree. 2026 Health Value Award. Fiduciary process documented. 30 to 40 percent health-plan savings for 100 to 2,000 employee CFOs. 3x number one bestseller.

The Middleman in Your Company's Medicine Cabinet | PBMs Explained

6 Jul 2026 · 1 min

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In a concise monologue aimed at corporate finance leaders, Paul H. Flowers Jr. warns that pharmacy benefit managers (PBMs) act as a profit‑driven middleman between employees and their prescription drugs. He explains that PBMs write the contracts that determine which drugs are covered, negotiate rebates with manufacturers, and often retain the rebate spread, which inflates drug costs and boosts the PBM’s earnings. This dynamic directly affects a company’s profit‑and‑loss statement, especially as pharmacy spend becomes a fast‑growing expense line. Flowers urges CFOs to scrutinize their PBM contracts and ask a single, critical question before renewal: “Who keeps the rebates?” He directs listeners to his website for deeper financial analysis.

Chapters

There's a middleman standing between your employees and their medicine, and he gets paid more when the price goes up. CFOs, look at your P&L. Pharmacy is the fastest growing line you've got, and the company managing it wrote its own contract. They decide which drugs your plan covers, they negotiate the rebates, and in too many contracts, they keep the difference. Meanwhile, somebody on your team is standing at a pharmacy counter doing math on a copay that just doubled. So ask one question before you renew: who keeps the rebates? I'm Paul H. Flowers Jr. Run your numbers at paulflowersjr.com.