Medco's Clash With Clarity

Last year, an upstart pharmacy benefit manager for the first time snagged the kind of huge account that normally goes to industry giants like Medco Health Solutions (MHS Quote) and Caremark Rx (CMX Quote).

Envision Pharmaceutical Services won over an international labor union and a big health insurance network, in large part by promising so-called transparency. That is, Envision pledged to disclose and turn over all the incentives it receives from drug manufacturers in exchange for a flat administrative fee.

The Sheet Metal Workers International Association, negotiating on behalf of some 150,000 members and their families, felt that the deal made sense. ...