See Beyond the Discounts. Focus on What Drives Real Savings.
Independent clinical management reveals
the real drivers of pharmacy spend and
how to control them.
HR teams are increasingly challenged to balance two seemingly conflicting goals – offering sustainable pharmacy benefits while controlling plan costs and ensuring exceptional member care.
A healthy balance is achievable when you apply strategic clinical management led by pharmacists – not algorithms – that targets the high-cost drug categories causing the most substantial plan impact.
Consider that*:
~2% of a plan’s prescription claims = ~50% of total pharmacy benefits plan costs*
~80% of new drugs are specialty medications**
~50% of new drugs exceed $150K annually**
*Based on RxBenefits Book of Business, 2024
**IQVIA Institute, The Use of Medicines in the U.S. 2022
Why clinical management matters:
Traditional PBMs without independent clinical management use algorithms to make coverage decisions on high-cost brand and specialty drugs, meaning inappropriate or off-label prescriptions may slip through, driving up costs and compromising outcomes.
What sets RxBenefits’ independent clinical model apart:
Achieves the lowest net cost by focusing on the small number of members driving costs while minimizing member disruption
Ensures appropriate medication use through prior authorizations led by licensed pharmacists
Targets high-impact savings opportunities through personalized support for your highest-cost members
Replaces costly, low-value drugs on the formulary with lower-cost, clinically-equivalent options
Discover how this model fits your organization’s strategy. Start the conversation with your benefits advisor.
