Why zero-dollar copays on medications are the future of employer-sponsored pharmacy benefits
6 Minutes
Team Curative
Kassie Herbst
Mar 10, 2026
Medication adherence is a serious issue.
Every year, according to a 2022 article, poor adherence results in $500B+ in avoidable health care costs and accounts for both 125,000 potentially preventable deaths and up to 25% of U.S. hospitalizations.
Cutting out copays is a direct path to medication adherence. But the traditional pharmacy benefit model doesn’t do that. It relies on rebates and cost-sharing: driving up costs while limiting access.
Kassie Herbst, Curative’s Senior Director of Pharmacy Benefits, has seen the system's dysfunction from multiple POVs — as a pharmacist, a clinical program innovator for Cigna, and a formulary director at a startup PBM.
Herbst knows that slashing copays to $0 can reduce your total pharmacy spend and improve workforce health outcomes, too. Value-based formularies deliver far better financial and clinical outcomes: Here, she shares how to implement them at your company.
Key takeaways:
Traditional PBM rebate models are costing employers millions in hidden fees.
Evidence-based formularies with $0 copays reduce total pharmacy spend while improving health outcomes.
Transparency and speed are critical to maximizing savings.
The rebate shell game that’s destroying employer value
A lot of employers think they’re getting value from rebate programs, but what they’re really seeing is higher spend driven by prioritizing higher-priced drugs, allowing middlemen to capture more revenue from every dollar spent.
"There's no transparency when it comes to rebates,” Herbst says, “and a lot of times, middlemen are able to capture a lot of the value rather than passing that through to employers and to members.”
Benefits managers can often focus their energy on managing visible copays, so they may not notice the hidden premium inflation associated with high-cost drugs on the formulary.
Herbst uses Stelara as an example. It’s a high-cost medication used to treat Crohn's Disease, ulcerative colitis, and other inflammatory conditions– and it has a biosimilar drug. That biosimilar drug costs ~90% less and works just as well.
But when a formulary includes Stelara, members are incentivized to get it rather than the lower-cost biosimilar alternative.
"The cost of that Stelara price tag is then being transmitted to the employer group, and down to the member as part of premiums," Herbst says.
And the PBMs can capture rebate revenue and keep a huge portion of it. With every transaction, there’s the rebate value and additional revenue in the form of fees. Even PBMs that pass on 100% of “rebates” don’t usually include those “hidden” fees – they keep them.
"There's no transparency when it comes to rebates, and too often middlemen capture a lot of the value rather than passing it through to employers and to members.”
Rebate arrangements are often convoluted and lack transparency, Herbst says, incentivizing use of the higher-cost brand-name drug.
As a result, employer groups unknowingly overpay millions of dollars monthly for pharmacy benefits while their members struggle with medication affordability. This creates a path to poor health outcomes that increases otherwise preventable hospitalizations, ultimately driving up total healthcare costs.
Aligning incentives through transparency and evidence
Employees and their employers can benefit from a formulary developed based on evidence. At Curative, that’s the charge Herbst is leading: a value-based formulary design.
When building Curative’s value-based formulary, the first consideration is evidence: that comes from evaluating clinical evidence, patient outcomes, and cost-effectiveness.
"If the evidence is there, even the highest-cost cancer drugs are available to members for a $0 copay," Herbst says.
She adds: “We always want to consider the member perspective. We want to help our members be on the medication that's actually going to help them and improve their quality of life.”
Implementing the value-based formulary involved decoupling PBM revenue from drug pricing, eliminating rebate-driven formulary incentives, and establishing transparent pricing models for employer groups.
“Remove the barrier to access, and then patients will be able to get what they need,” Herbst says.
What that looks like at Curative:
$0 copays for evidence-based medications
Rapid formulary updates when generics & biosimilars become available
Complete clarity in drug pricing and savings
Employers are becoming increasingly frustrated with traditional PBM models that fail to deliver actual cost savings, so they’re making moves toward value-based care models that put outcomes first.
“We will continue focusing on transparent, evidence-first solutions as the way to disrupt that broader payer space,” Herbst says.
How to transform your pharmacy benefits
Keep these five principles in mind as you explore a value-based system.
Evidence drives economics “We heavily rely on data-driven evidence to make a decision about what our members are actually going to need and benefit from,” Herbst says. Part of that means cutting costs from early clinical evaluations to ensure you’re reviewing the best options.
Transparency creates accountability It’s a lack of transparency that makes the current pharmacy health care model so difficult to navigate. "As long as hidden fee structures and clouded drug pricing persist,” Herbst says, “it's going to be a problem that continues to surface.”
Full visibility into drug pricing helps you make informed decisions.
Access drives better adherence and outcomes When copays drop to $0 and members gain access to medications they previously couldn’t afford or couldn't access, they are more likely to stick to their medication regimen, which reduces downstream health care costs for you, their employer.
Speed is essential in generic & biosimilar drug transitions “Curative acts fast” when a generic or biosimilar becomes available, Herbst says. “We want to make sure that we're capitalizing on that access for our members as soon as possible.” That’s an easy way to maximize savings.
Education enables adoption It’s essential for members to understand what’s available to them and what the evidence-based formulary entails. Curative provides education and training to that effect. Stakeholders at all levels should understand the system and be ready to buy in for ultimate success in the workplace.
Still, some employers will balk at cutting copays. But ask them if you can afford not to cut them. The cascading costs of poor adherence hurt both your workforce and your bottom line.
Employers who adopt pharmacy benefits with evidence-based formularies will save money, achieve better health outcomes, and create a competitive advantage in attracting and retaining healthier, more productive talent.
Frequently asked questions
Does eliminating copays encourage overuse of medications and drive up costs?
Actually, the opposite happens. When copays for evidence-based medications drop to $0, adherence improves, which prevents expensive complications and hospitalizations down the line.
By removing financial barriers to necessary treatments while cutting out high-cost brand names that have equally effective generic alternatives, employers see a decrease in their total pharmacy spend.
How can we trust that a $0 copay formulary won't just shift costs elsewhere?
Traditional PBM models hide costs in rebates and spread pricing. You might see low copays at the pharmacy counter, but those costs get baked into premiums and passed back to employers through opaque fee structures.
A value-based formulary with transparent pricing eliminates those middleman markups entirely. You'll have complete visibility into the actual costs of drugs and where your money goes, with savings generated from rapid generic and biosimilar adoption and formulary decisions based on clinical evidence.
What happens if an employee needs a medication that isn't on the value-based formulary?
Curative’s formulary covers a drug for almost all conditions.
For rare cases where a patient has a documented medical need for a non-formulary medication, there are exception processes in place to ensure they can access it. The goal of a value-based formulary isn't to restrict necessary care — it's to eliminate waste on overpriced drugs that don't deliver better outcomes than the generics.
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Table of Contents
Key takeaways:
The rebate shell game that’s destroying employer value
Aligning incentives through transparency and evidence
How to transform your pharmacy benefits
Frequently asked questions
