This pharmacy industry veteran is hoping to ‘put the clinical focus’ back in PBMs

After spending nearly seven years at Big 3 pharmacy benefit manager (PBM) CVS Caremark, pharmacy industry veteran Ritu Malhotra recently joined a brand-new alternative PBM, Illuminate Rx, as president.

Illuminate Rx, which launched on Sept. 10, 2025, is an affiliate of RxBenefits, a pharmacy benefits optimization company founded in 1995.

What makes it different from the standard PBM, according to Malhotra, is Illuminate Rx is “very clear” about where its money comes from: an administrative fee “that captures all of the costs associated with administering the plan.”

“What that allows for is a level of flexibility and customization that just doesn’t really happen at the bigger PBMs because they’re taking risk in a different way,” she said.

The PBM is also unique in the fact that it employs a large portion of clinicians relative to the company’s overall size, Malhotra added.

“I was shocked when I found that out,” she said. “We’re putting the clinical focus back into pharmacy benefits. So much of it was about cost for so long, with prior authorizations and other clinical programs really just being barriers to care as opposed to having a clinical point of view.”

Looking back. Malhotra, a pharmacist by training, spent most of her career as a pharmacy benefits consultant. During those 15 years, her day-to-day was largely spent working directly with health plan sponsors, including employers and union groups.

She transitioned away from consulting to Caremark in 2018, where she started as VP of client solutions. She held a number of titles during her time at the company, serving most recently as the VP of PBM innovation before she left in 2025.

“What was interesting about leaving consulting and going to the CVS Caremark team was…seeing a different side of the industry,” Malhotra said. “So much of my time [had been] negotiating against the Big 3 PBMs…and I was getting the opportunity to go into one, learn about how they were essentially proposing their pricing to me as the consultant for those 15 years prior.”

At Caremark, she focused on building new products, solutions, and pricing models “that would hopefully bring down the cost of the pharmacy benefits that Caremark was offering,” she said.

Between Caremark and Illuminate Rx, Malhotra spent a year founding a drug affordability platform called Andel, for which she continues to serve as an advisor. In her new role at Illuminate Rx, Malhotra said she’s looking forward to getting back out into the market and working with clients again.

The broader picture. Malhotra recognizes the PBM industry is in a pivotal moment.

“What I’ve noticed over almost 25 years now is every couple of years there was this ebb and flow…as the industry, particularly in DC, would start to recognize that this was a complex space,” she said. “Nobody really understood the value of the PBM, so it’s easy to point the finger to, ‘That’s where the problem lies.’”

About four years ago, that wave of finger pointing started up again—but then it never stopped, according to Malhotra. The federal government even got involved, with the Federal Trade Commission suing the Big 3 in 2024. The agency announced in February 2026 it had reached a settlement with one of the PBMs, Express Scripts, which required the company to “fundamentally change” its business practices, including prioritizing expensive drugs on its formulary.

“I do see the entire market changing,” she said. “We will not go back to the status quo this time around.”

But we’re still in the early innings of change, she added. “Everybody’s throwing some potential ideas out on the table as to how we can manage prescription drug costs, but I don’t know that we’ve landed on a solution,” she said.

The PBM reforms passed by Congress in early February were “a long time coming,” according to Malhotra. And while she said she can “see the purpose of what they’re trying to accomplish,” she’s unclear on what the execution will look like, as the legislation didn’t lay out clear penalties for PBMs that fail to adhere to the new rules.

As for Illuminate Rx, the reforms won’t have an impact, according to Malhotra, because the PBM was built to be transparent from the get-go.

“We had always intended Illuminate to offer full transparency, being very clear on what pricing we have access to and passing that straight through with no hidden fees,” she said.