In this episode of Benefits Broker Boost, Adam Smith is joined by Dr. Jonathon Harrison, a pharmacist and the CEO and founder of Wellyfe. Dr. Harrison discusses how his "win-win-win" PBM model is disrupting traditional pharmacy benefits by turning local healthcare providers into community-centric powerhouses. The conversation highlights how brokers can move beyond simple cost-savings spreadsheets to offer a strategy that generates new revenue while drastically reducing expenses.
Dr. Harrison argues that traditional Pharmacy Benefit Managers (PBMs) are fundamentally misaligned with the needs of employers and patients. He explains that traditional models prioritize "fluff profit" through spread pricing, opaque fees, and rebates that actually incentivize higher drug prices. Instead of extracting value from communities, Dr. Harrison’s approach focuses on transparency and clinical value, moving away from the complex financial structures that often leave Americans choosing between medication and basic needs like rent or food.
Turning Health Centers into Local PBMs
The Wellyfe model works by empowering Federally Qualified Health Centers (FQHCs) and hospitals to become their own local community PBMs. Operationally, these organizations white-label Wellyfe’s infrastructure to manage claims, prior authorizations, and clinical services. By utilizing wholesale acquisition cost pricing instead of the traditional AWP model, these facilities can save up to 60% on their own employee benefit programs. This keeps healthcare dollars within the local economy rather than funneling them to distant corporate headquarters.
A New Growth Strategy for Brokers
For brokers looking to differentiate themselves, Dr. Harrison suggests moving away from standard spreadsheets and walking into meetings with a revenue-generation strategy. Once a local hospital or FQHC is established as a PBM hub, brokers can approach other self-funded community employers to "piggyback" off that network. This allows the external employers to see 30% to 40% savings while simultaneously creating a new revenue stream for the local health center. This dual impact makes it incredibly difficult for competing brokers to unseat the incumbent.
Enhancing Patient Experience and Access
Beyond the financial benefits, the local PBM model improves the member experience by restoring the human element to pharmacy care. By removing the friction of mail-order-only requirements and PBM-owned specialty pharmacies, patients gain higher adherence and better health outcomes. Dr. Harrison emphasizes that having a local, physical hub reduces member anxiety and results in fewer angry emails to HR departments, as employees can pop into a local pharmacy to resolve issues rather than calling someone in a different time zone.
Ensuring National Coverage with a Tiered Network
To accommodate brokers with clients across multiple states, Wellyfe utilizes a three-tiered network approach:
Tier One (The Hub): The health center or hospital serving as the primary, most cost-effective location for care.
Tier Two (Secondary Network): Local independent pharmacies within the area that have established relationships with the hub.
Tier Three (National RAP Network): A wrap network of 67,000 pharmacies nationwide that ensures employees have access to medication while traveling or on vacation.
Looking toward 2026, Dr. Harrison predicts a shift where manufacturers may go direct to consumers and employers, further cutting out traditional PBM middlemen. He believes "Direct Pharmacy Care" is here to stay as organizations stop following the "old playbook" of unavoidable high costs and demand true transparency. Wellyfe aims to drive this change by building "mini powerhouses" for local economies that prioritize people over opaque profit margins.
This episode is sponsored by Plansight. Plansight is the only end-to-end benefits marketing platform that uses AI and automation to ensure every renewal and RFP is consistent, accurate, and fast. By taking the manual work out of benefit planning, Plansight helps you stay ahead of the curve and deliver faster, smarter results to your clients. Visit Plansight to learn more about making your brokerage more efficient.
