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Case Study: University of Utah Health Plans

Overview

Turning Pharmacy Benefits Into Ownership, Savings, and Strategic Control

University of Utah Health Plans partnered to fundamentally change how pharmacy benefits are managed—moving away from a traditional PBM vendor model and into a structure that creates ownership, transparency, and financial return.

Instead of simply paying a PBM to manage claims, the organization implemented a model where they could control pharmacy economics, access real performance data, and capture value directly within their own system.

The Challenge

Like many health plans, University of Utah Health Plans was operating within a traditional PBM structure characterized by:

  • Limited visibility into true drug costs
  • Misaligned incentives between cost savings and PBM revenue
  • Value flowing out of the organization instead of back into it
  • Difficulty turning pharmacy spend into a strategic advantage

Even as pharmacy costs continued to rise, the underlying model did not allow for meaningful control or ownership of the financial outcomes.

The Solution

By shifting to a PBM ownership-based model, University of Utah Health Plans was able to:

  • Gain direct control over pharmacy benefit design and economics
  • Improve transparency across pricing, claims, and utilization data
  • Align pharmacy strategy with organizational goals and member outcomes
  • Transition pharmacy spend from a passive cost center into a managed, value-generating asset

This structure created the ability not just to manage pharmacy benefits—but to actively shape and benefit from their performance.

Conclusion

This case demonstrates a broader shift in pharmacy benefits:

Organizations no longer have to accept pharmacy benefits as a fixed expense. With the right structure, they can become:

  • Owners instead of buyers
  • Decision-makers instead of bystanders
  • Beneficiaries of the value they create