Pharmacy Forward Podcast, Episode 3
Welcome to Episode 3 of Pharmacy Forward: What is Transparency featuring Schlukebier, President and Scott Webb, Chief Growth Officer.
Join our host Lesley Pink as she and our guests as they explore what transparency really means in pharmacy benefits and why it has become a baseline expectation for plan sponsors rather than a nice-to-have.
The takeaway: show it, explain it, and activate it.
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Episode Transcript
Are you looking to stay ahead of breaking news, trends, and resources related to the pharmacy market and drug pricing? Tune in to Gateway Health Partners’ podcast, Pharmacy Forward: Insights from Insiders, a quarterly podcast featuring pharmacy experts who have the inside scoop on the pharmacy market, drug costs, and clinical hot topics.
What is Transparency?
Lesley Pink
Hello and welcome to Pharmacy Forward: Insights from Insiders. I’m Lesley Pink, your host. Today we’ll be talking about the meaning of transparency in the industry. We’ll talk with two people from Gateway Health Partners, Rachel Schlukebier, the president, and Scott Webb, the chief growth officer.
Rachel has been with Gateway since 2020 and became president earlier this year. Scott started at Gateway eight years ago and became chief growth officer earlier this year. Welcome to the podcast, Rachel and Scott.
Rachel Schlukebier
Thanks, Lesley.
Lesley Pink
How has the meaning of transparency evolved over the last few years and what is driving the shift? Do you think the industry has kept pace with expectations?
Rachel Schlukebier
I think the CAA is fundamentally raising the bar, with employers now having a fiduciary responsibility to demonstrate that they’ve reviewed costs and outcomes, and the regulators are watching. Frankly, historically, the industry hasn’t really kept pace. It’s part of the reason I believe the CAA has come to be.
Many PBMs have still defaulted to proprietary data structures and aggregate-only reporting, and Gateway’s been very intentional about getting ahead of this. The 2029 deadline isn’t a finish line for us. It’s a floor we intend to clear well before then.
Scott, do you have thoughts?
Scott A. Webb
I do. I’ll speak a little bit from the rebate perspective, but transparency used to be a buzzword. Now it’s table stakes. Clients do not just want a spreadsheet after the fact. They want to understand how rebates are earned, how they flow, what assumptions were made, and what actions they should take. Has the industry kept pace? In pockets, I feel, yes; as a whole, no. Exceptions move faster than the traditional PBM and rebate model. The market’s asking for headlights, not a rearview mirror.
Lesley Pink
There’s a difference between transparency and visibility. How do you define each one and why does the distinction matter?
Rachel Schlukebier
Visibility, to me, is more about access. Can you see your data? Can you see your information? Transparency is about understanding. Do you know what your data is telling you? Do you know what it means? What drove the performance? In the CAA environment, employers have a legal obligation to act as prudent purchasers. That requires more than just a dashboard. It requires context, plain-language explanations, and a partner willing to say, “Here’s what this means for you,” not just, “Here’s your report.” And that’s a real focus for Gateway and our strategy moving forward.
Scott A. Webb
Rachel, that’s great. And I’ll just add, I agree 100%. That distinction matters because a dashboard full of numbers can still leave a client confused. I see it all the time. Visibility shows the picture; transparency explains the story. At Gateway, we explain the story so clients, prospects, and folks in the market aren’t confused.
Lesley Pink
Why can transparency be hard to achieve in this industry?
Scott A. Webb
Rachel, I can start this one if you want. I love this question. And I talk about this all the time with groups in the industry, the ecosystem, the landscape, whatever you want to call it. This industry was not built to be simple. You have PBMs, manufacturers, aggregators, contracts, exclusions, guarantees.
I can go on and on. Claims logic, timing issues, and data moving through multiple hands. When someone says, just show me everything, I usually smile and think, great. Now let’s define everything. The hard part is not wanting to be transparent. The hard part is making complex information accurate, usable, and explainable.
I’ll say it again: at Gateway, that’s exactly what we do. We don’t pull any punches. We take the complexities out of the mix, give you the information you need, make sure it’s tied to predictability and sound data, and then we explain it along the way.
Rachel, what are your thoughts?
Rachel Schlukebier
Yeah, I think you’re spot on, Scott. There’s a lot of historical incentive misalignment, legacy contracting structures, and historical reliance on rebate opacity that make it difficult. And some players in this space have built business models that depend on clients not understanding the full picture.
To Scott’s point, you know, Gateway has made deliberate choices to structure our model differently because we believe when clients understand what they’re buying and why it’s working, they stay and they grow with us.
Lesley Pink
How do you hold yourselves accountable when transparency reveals a problem on your end?
Rachel Schlukebier
Honestly, this is where the rubber meets the road. We’ve certainly had moments where our own data showed us something we didn’t like, a trend perhaps that’s missed, a recommendation didn’t land the way that we intended. The temptation in this industry is to bury that in a footnote or wait for a client to notice, and Gateway’s made a deliberate choice to do the opposite.
Scott A. Webb
Yeah.
Rachel Schlukebier
We will be bringing it to the table first, explain what happened, and come with a plan to fix it. If we’re only transparent when it reflects well on us, that’s not transparency. That’s marketing.
Lesley Pink
And you touched on this a little bit. What is Gateway’s philosophy on transparency and how does it show up in the way you work with clients?
Scott A. Webb
Yes. I can tell you we own it. There’s no dancing. There’s no hiding. There’s no, “Let me circle back,” or those types of smoke screens. If transparency shows we missed something, we explain what happened, what the impact was, what we’re going to fix, and how we prevent it from happening again.
We truly do that. That’s where the trust is built. Not when everything is perfect because that’s easy to do. But when something is imperfect, we handle it the right way and we build very, very sound relationships that are long term.
Rachel Schlukebier
Our philosophy is that a client who understands their data is going to make better decisions, and that’s good for everyone. In practice, it means we’re providing claim-level detail, not summaries. We’re holding quarterly business reviews. We’re bringing recommendations, not retrospectives. And when the data tells the client a story they may not want to hear, we tell it anyway, to Scott’s point. I mean, that’s the real work of a strong partner.
Scott A. Webb
And I’ll just add, I love this question. We always talk about data, like Rachel just said, and we lead with predictability, which allows our clients to benchmark and forecast and make the right decisions for their business, for their clients’ business, and for anyone touching that model who needs to create a splash in the market or just better understand it and how to navigate it. And that’s where Gateway comes in. We really, really stand behind that.
Lesley Pink
So what’s the difference between reporting that checks a box and analytics that drives decisions? How do you know when a client is getting real value from their analysis versus just receiving a report?
Rachel Schlukebier
So I would say box checking, reporting answers sort of what happened. Actionable analytics answers the what should we do next. The signal that a client is getting real value is when they come back and say, we saw this trend that you flagged and here’s the decision we made.
If the client is just receiving information and there’s not that communication and collaboration together, something’s wrong, either with how we’re presenting data or recommendations or how we’re following up. We treat analytics as the start of the conversation, really not the end of it.
Scott A. Webb
I agree with that, too. If a client receives a report and nothing changes, can you imagine? That’s a box checked. If a client uses the information to change strategy, ask better questions, improve their actual performance, or avoid a bad decision, that’s real value.
Lesley Pink
What information should good analytics deliver for an employer or health plan? And how do you tailor analytics to different types of clients, like a small employer versus a large plan, for example?
Rachel Schlukebier
At its core, good analytics show where the spend is going, why it’s moving, and what levers exist to manage it. But you’ve got to kind of have it in context. A 200-life employer group and a regional health plan are going to have very different decisions and very different decision-making contexts. For a smaller employer, you are going to need to lean into benchmarking and simplicity. They need to know if they’re paying too much and what to do about it. For a health plan, we may go deeper into formulary performance and trend attribution. The platform is the same, but the story we tell is tailored to their unique business needs.
Scott A. Webb
Oh, Rachel, you stole mine. The art is telling the story to the audience. We truly believe in customizing things for whoever we’re speaking to. From my perspective, good analytics should answer four questions. What happened? Why did it happen? What’s the risk? And what should we do next? Very simple.
But it really helps everyone get aligned and understand what the next steps are. For example, for employers, that may mean cost trend, member impact, guaranteed performance, and net cost. For health plans, it may go deeper into formulary strategy. It could be rebate performance, clinical programs, or regulatory readiness. Same data universe, different decision makers. Like Rachel said, the art is tailoring the story to the audience.
Lesley Pink
And again, you touched on this a bit. What does it mean to go beyond the data and tell a client what to do with it? Can you give us an example of when real guidance led to a meaningful outcome for a client?
Scott A. Webb
To me, it means stop being a data delivery service and start being a strategic partner, ultimately. So, for example, if analytics show a formulary change may improve rebate value but increase disruption, we should not just hand over the numbers. We should help the client weigh savings, member impact, operations, timing, and risk.
Like we just said, data gives you options—predictability, benchmarking, and forecasting. Guidance helps you choose wisely. And I feel like we do that daily with our clients, and especially with the prospects coming in. We use the data to help them make a very informed decision, but then we guide them to make sure that informed decision drives meaningful outcomes and impact for everyone they touch within the ecosystem.
Lesley Pink
How do you make sure that transparency doesn’t just live in a dashboard, that the right people in a client organization are actually using it?
Rachel Schlukebier
I think that’s where, as we’ve been talking through this podcast, data is only beneficial to you if you can operationalize it. How can you take that data, consume it, and do something meaningful with it? We spend real time thinking about who needs to understand what and at what level of detail. A CFO is going to need different information and a different story than a benefits administrator, for example. So part of our work is really helping clients translate that data into the language of whatever audience they’re bringing it to or whatever they internally may need. Because the dashboard that sits unopened isn’t transparency. It’s really just a subscription.
Lesley Pink
How do you measure whether transparency is actually improving outcomes and not just satisfaction?
Scott A. Webb
I’ll run with this a little bit, Rachel. I think it ties into the last question, Lesley. You measure behavior and results, not just satisfaction. Are clients making faster decisions? Are they identifying issues earlier? Are they improving guaranteed performance, reducing surprises, and, you know, are they better prepared for audits, renewals, and this regulatory environment and the requirements or demands that it’s putting on everyone? If transparency does not improve outcomes, it’s just a prettier flashlight, from my opinion. It really, really has to improve those outcomes.
Rachel Schlukebier
I think Scott’s spot on with his commentary, and satisfaction matters, but it’s really not enough, right? We’ve got to look at whether the trend is moving relative to benchmarks, whether the clients are making different decisions than they were a year ago, and whether we’re catching issues earlier. We’re going to track recommendations we make and follow up on outcomes.
If we told a client six months ago that their specialty utilization was an outlier—high compared to the benchmark—and they acted on it, we want to show them what happened. That closes that conversation loop and keeps us honest. If our recommendations aren’t leading to outcomes, we need to know that, too. So, to Scott’s point, it’s really ensuring that what we’re doing is having meaningful impact.
Lesley Pink
What should employers and health plans be asking to see and what questions should they be asking that they aren’t?
Rachel Schlukebier
They should be asking, “Can I see my net cost per claim after all fees, rebates, and spread? Can you show me how my formulary decisions compare to my peers or those in the same type of business? What would I pay in a past-year model?” The questions most aren’t asking are, “What conflicts of interest does my PBM have in recommending this formulary?” We welcome that question because we can answer it clearly. This isn’t a space where we should be hiding behind historical behaviors, but really at the forefront of opening up and being a true business partner with our clients.
Scott A. Webb
They should be asking to see the full financial picture. And then after you do that, what decisions should I make because of this? I don’t think enough clients or groups you work with ask that basic question. Okay, great. I have, where did the rebate come from? What was excluded?
What was estimated versus paid? I’m asking the right questions, but now what do I do? And that’s where Gateway comes in. Our experience, our expertise, years in the market—we’ve seen it all. I’ve seen the bad actors. We’ve seen the shifts. We’ve seen the legislative market; it ebbs and flows. What decisions should I make because of the information you’re giving me? How can you help me?
Lesley Pink
And what should a client do if their current rebate vendor won’t give them what you’re describing?
Scott A. Webb
Come to Gateway.
Rachel Schlukebier
Yeah, I mean, that’s the best answer. I would ask explicitly and get the refusal in writing. Eventually, this sort of falls to the wayside once CAA becomes a requirement. But plan sponsors have a right to own their data, and a vendor who won’t provide it may be creating a compliance risk for that client once 2029 comes to play. Second, get clear on what you’re actually receiving versus what you’re entitled to. I think sometimes there’s a misunderstanding of what clients are getting. And that’s where Gateway’s, you know, a good partner. We really strive to, when clients onboard, you’re going to get a walkthrough of what’s in all of your reporting on your first payment. And that I think is very valuable. Thirdly, talk to an independent benefits consultant.
Use the contractors and the consultants in the market space to really get a sense of what am I receiving, what should I be receiving that I’m not receiving. We’d rather a client come to that conversation, you know, informed than switch to us because we promise something better. We want clients to know what’s available in the market space and what they deserve. And frankly, if a client, you know, comes to us with a request or a question that we can’t answer them clearly, they should hold us to that standard and we should be able to meet their requests.
Lesley Pink
And Rachel, you had mentioned the CAA. How are you preparing clients for their own CAA applications and not just yours?
Rachel Schlukebier
CAA is really shifting that responsibility to the plan sponsors. So, employers and health plans have to demonstrate that they’ve reviewed costs and acted as prudent purchasers. Part of our job is helping clients understand what they need to document and what questions they need to be able to answer if the regulator comes knocking, but we always tell them to loop in their compliance and legal teams on specifics. We will ensure that we have the data needed to answer those questions. The deadline is real. It’s coming. And we’d rather our clients be ready early.
As I made in an earlier point, it’s a benchmark and a bare minimum for us. It’s not about being ready in 2029. It’s about being 2029-ready today.
Scott A. Webb
I like that. And I’ll just add, you know, there is panic in the streets. We’re helping our clients move from panic to being prepared and doing exactly what Rachel just said. Let us help you. Let us help you prepare. Take the panic out of the mix and show you that there’s a clear path ahead as we partner and do this the right way.
Lesley Pink
What does the transition look like for a client who’s never had this level of transparency before?
Scott A. Webb
Hey, you know, I’ll run with this quickly, Rachel, because I heard something yesterday that was great. At first, it can feel like turning the lights on in a messy garage. There’s a lot to look at. Some of it’s exciting, some of it’s uncomfortable, and some of it makes you say, “Why didn’t we know this before?”
So we pace it. Start with education, then baseline the data, then define what matters, then move into recurring insights and action, which is key. And the goal is not to overwhelm the client. It’s to make them smarter every cycle, every step of the way. We truly partner all the way through, like I said earlier. We help you navigate the storm, find some of those clear waters, and then pivot again and work through whatever comes next.
Lesley Pink
And my final question, what is Gateway’s approach to turning transparency into something clients can act on?
Rachel Schlukebier
As we’ve been talking about, transparency without activation is just information. Our job is to close the loop, take what the data shows, frame it in terms of decisions a client can actually make, and then be there to help them execute. That’s what it means to be a partner rather than a vendor. Vendors send reports. Partners show up with answers. As we move toward CAA compliance across the industry, organizations that will earn long-term trust are the ones who’ve been doing this work all along, not scrambling to comply at the deadline.
Scott A. Webb
We want to help clients save money, reduce surprises. Nobody likes a surprise, especially if you get blindsided. Meet obligations and just make better decisions. So basically show it, explain it, and activate it.
Lesley Pink
Well, thank you, Rachel and Scott, for joining us for the July podcast of Pharmacy Forward. Please join us for the next podcast in the fall and remember that you can find us on Apple Podcasts, Spotify, and YouTube.
About Pharmacy Forward: Insights from Insiders
Are you looking to stay ahead of breaking news, trends, and resources related to the pharmacy market and drug pricing? Tune in to Gateway Health Partners’ podcast, Pharmacy Forward: Insights from Insiders, a quarterly podcast featuring pharmacy experts who have the inside scoop on the pharmacy market, drug costs, and clinical hot topics.
