Drive Smarter Pharmacy Decisions with Peer-Led Clinical Support
How RxBenefits’ pharmacist-led
independent clinical management
helps improve outcomes
Hospital pharmacy leaders are no strangers to the pressures of rising costs, clinical complexity, and limited resources. With expensive specialty drugs and GLP-1s driving pharmacy spend – and operational capacity stretched thin – there’s a growing need for data, insights, and support to help relieve the burden
With independent clinical management that delivers actionable insights, expert peer review, and targeted interventions, RxBenefits can be a powerful extension of your team. Conducted by clinicians – not algorithms – and focused on the high-cost drug categories that have the greatest impact, it can help reduce inappropriate prescribing and ensure better outcomes.
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 How clinical management makes your pharmacy plan more efficient:
Traditional PBMs without independent clinical management use algorithms to make coverage decisions on high-cost brand and specialty drugs. As a result, inappropriate or off-label prescriptions may slip through, driving up costs and member risk.
What’s more, these decisions often occur without input from the people who know the pharmacy best: pharmacists.
How independent clinical management keeps pharmacy at the table
RxBenefits’ independent clinical model supports hospitals and health systems with actionable insights, peer-led decision-making, and high-touch support, keeping pharmacists directly engaged in employee benefits decisions. Our reviews focus on what matters most: the small number of claims creating the biggest financial and clinical impact.
appropriate medication use
Ensures appropriate medication
controlled costs
Unsure of where to begin?
Share this guide with your HR partners or connect with our
hospital experts to guide you through the next steps.
