Cutting Pharmacy Benefit Costs Without Cutting Care

Introduction

Employers often feel stuck between two bad options: reduce pharmacy costs by limiting coverage or accept rising expenses year after year. But there’s a better path. By modernizing how pharmacy benefits are managed, organizations can lower spend and improve member health outcomes.

Why Cost and Care Feel at Odds

Traditional PBM structures often reward volume and high-priced drugs. Employers fear that lowering costs means restricting coverage, frustrating members, and risking compliance.

The truth: smarter pharmacy benefit management proves you can achieve both affordability and quality.

Smarter Approaches That Work

1. Clinical Review at the Right Time
   AI-driven reviews flag duplicate therapies and unnecessary specialty prescriptions before they drive up costs.

2. Formulary Optimization
   Transparent PBMs help design formularies that balance affordability with evidence-based treatment options.

3. Adherence Support
   Encouraging members to stay on lower-cost maintenance medications prevents expensive ER visits later.

Case Example

A regional employer saved 12% on drug spend while simultaneously improving adherence rates among employees with chronic conditions by 9%. The result: healthier employees and lower long-term costs.

Conclusion

Cost savings don’t have to come at the expense of member care. With the right PBM partner, organizations can have both.