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:

Ensures pharmacy plan is administered according to your design

Confirms dosing and use align with FDA-approved guidelines

Flags inappropriate or potentially unsafe prescriptions before they’re filled

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.

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