This document is the written testimony of Keith Bruhnsen from the University of Michigan, which operates a large, self-insured prescription drug plan. Bruhnsen discusses the university's experience contracting with PBMs over the past 10 years, including its focus on managing toward the lowest net cost, ensuring appropriate drug utilization, and the need for transparency in PBM compensation and fees to hold PBMs accountable and secure the best value for the plan.