Prescription & Rx Cost Management
Independent guidance on pharmacy benefits, PBM contracts, and GLP-1 coverage strategy — so you control the fastest-rising line item in your health plan.
Prescription drugs — and specialty and GLP-1 medications in particular — are the fastest-growing component of employer health costs. A small number of high-cost claimants can reshape an entire group's claims experience, and because most employers have little visibility into how their PBM is priced, those increases often show up unannounced at renewal. Controlling this spend starts with understanding exactly where the money is going.
GLP-1 medications such as Ozempic, Wegovy, and Mounjaro can cost $1,000–$1,500 per member per month, and utilization is climbing fast as demand for weight-loss and diabetes coverage surges. A handful of enrolled members can single-handedly swing a mid-size employer's renewal by double digits.
Unlike traditional maintenance drugs, GLP-1s are prescribed to a rapidly growing share of the workforce, and once members start therapy they often stay on it long-term. Without clear utilization data, clinical criteria, and a coverage strategy, employers see these costs flow straight into their claims experience and next renewal — often with no warning until the increase lands.
A Pharmacy Benefit Manager (PBM) is the middleman that administers your prescription drug benefit — negotiating rebates, setting formularies, and processing pharmacy claims. It matters because PBMs are frequently compensated through spread pricing and retained rebates that most employers never see.
The three largest PBMs control the vast majority of the market, and their contracts are notoriously opaque. Spread pricing, rebate retention, and steering toward higher-cost drugs can quietly inflate your pharmacy spend by double digits. Understanding — and renegotiating — how your PBM is actually paid is one of the highest-leverage cost levers available to an employer.
The answer is visibility and strategy, not blunt cuts. By auditing your PBM contract, modeling GLP-1 coverage scenarios, and applying evidence-based clinical criteria, employers can manage spend while keeping the benefits employees value most.
We help employers benchmark pharmacy costs, evaluate transparent and pass-through PBM options, and design GLP-1 coverage strategies that pair clinical oversight with cost controls. The goal is a sustainable pharmacy benefit — one where you know exactly what you are paying for, capture the rebates you are owed, and protect coverage for the people who genuinely need it.