— Service
Rx & Specialty Drug Analysis
Identify high-impact opportunities in pharmacy spend. Specialty drugs now account for over 50% of total drug spend for many employers — yet most have never audited their PBM contract or questioned their formulary.
Pharmacy Spend Pressure
— The Problem
Pharmacy Is the Fastest-Growing Cost Category — and the Least Transparent
Most employers accept their PBM contract at face value. Rebates are opaque. Formulary decisions are made by the PBM, not the employer. Specialty drug utilization is rarely analyzed at the member level. The result is billions in avoidable spend across U.S. employers every year.
- PBM contracts with hidden spread pricing and retained rebates
- Specialty drugs prescribed without clinical pathway review or alternative sourcing
- GLP-1 medications (Ozempic, Wegovy, Mounjaro) adding $500K+ to mid-market plans
- Formulary decisions that prioritize PBM revenue over employer cost
50%+
of total drug spend is specialty
+22%
specialty drug trend YoY
+48%
GLP-1 spend growth YoY
$15K+
— Deep Dive
What We Analyze
Here’s what a full Rx and specialty drug analysis covers.
01
PBM Contract Audit
We review pricing terms, rebate structures, spread pricing, dispensing fees, and contract guarantees. Most employers are leaving 15–25% on the table because they’ve never had an independent review.
02
Specialty Drug Utilization
We identify every specialty drug in your plan, evaluate clinical necessity, assess alternative sourcing (specialty pharmacies, biosimilars, manufacturer programs), and quantify savings potential.
03
Formulary Optimization
We analyze your current formulary against clinical guidelines and cost-effectiveness data. Many plans carry high-cost drugs where equally effective, lower-cost alternatives exist.
04
GLP-1 & High-Cost Drug Management
GLP-1 medications are the fastest-growing drug category. We help you build a clinically appropriate access strategy that controls cost without restricting medically necessary treatment.
05
Rebate Transparency Analysis
We calculate what you should be receiving in rebates vs. what your PBM is passing through. The gap is often substantial — and most employers don’t know it exists.
06
Generic Utilization & Dispensing
We measure your generic fill rate and identify opportunities to increase generic utilization through plan design, member education, and pharmacy network optimization.
—PROCESS
How the Analysis Works
We follow a structured approach to ensure every recommendation is grounded in your actual plan data.
01
Collect Rx Data
We request claims-level pharmacy data and your PBM contract from your current carrier or TPA.
02
Analyze & Benchmark
We run analytics on utilization, pricing, rebates, and formulary against market benchmarks.
03
Deliver Recommendations
We present findings with specific, prioritized actions ranked by savings impact and ease of implementation.
— What You Get
Expected Outcomes
15–25%
Typical PBM savings potential
Full
Rebate transparency
Specialty
Drug-level analysis
Actionable
Formulary recommendations
— Related Services
Explore Other Services
Is Your PBM Contract Costing
You More Than It Should?
Most employers have never had an independent Rx analysis. Start with a 15-minute conversation — we’ll tell you if there’s an opportunity worth pursuing.