How Health Benefit Consultants Can Save Employers $88 Per Member Per Year on Prescription Costs

Health benefit consultants can help their clients save up to $88 per member per year on prescription spending by sending actionable drug data to doctors within their existing workflows. Too often, provider communication is non-existent, inaccurate, limited, or cumbersome which prevents full savings potential. Member-based mobile solutions are limited; chasing members after prescription dispensing is expensive and disruptive. By partnering with Benmedica, consultants can significantly reduce their employers’ and members’ Rx costs, increase medication adherence, and improve patient outcomes.


Prescription Savings Opportunities for Employers

A recent claims-based opportunity analysis revealed that most employers are overspending on prescriptions by not providing enough actionable information to physicians at the time a prescription is written. For one 100,000-member plan, this demonstrated over $8.8 million per year in direct potential savings.

By optimizing the information sent to doctors through their Electronic Health Records (EHRs), employers can slash prescription spending and reap savings more efficiently than through other drug-spending strategies.  This stream of information to EHRs already exists as part of provider workflow but is underutilized.  Supplementing the existing information is a straightforward method with the right experience and knowledge.


Factors Contributing to Higher Drug Costs

The driving force behind employers paying for more expensive prescriptions is a widespread absence of physician access to drug coverage, cost information, and affordable alternatives options during the prescription-writing process. Without the ability to view this information, doctors can’t determine if they’re prescribing the most affordable option for their patients or use cost information to aid in prescription decisions.

A recent survey revealed physician perspectives on currently available Rx information:

  • 87% experience difficulty in understanding patients’ Rx costs
  • 78% desire information on patient prescription out-of-pocket costs
  • 69% want access to info on more affordable therapeutic alternatives


During patient visits, most physicians can only access drug coverage tier and preferred status through their EHRs. Prescribing data from 2018 shows that only 14% of prescribers have access to drug pricing within their EHRs. This leaves them with very little guidance on how much patients will pay at the pharmacy or what alternatives may be a better choice.

Below are illustrated mockups of how data may appear to physicians within EHRs. Figure 1 shows the typical information doctors can see when using their EHRs to write electronic prescriptions. The only cost indicator available is the drug’s tier level which doesn’t provide enough guidance to help the prescriber understand the patient’s copay or what cost-effective alternatives are available.

Figure 1

The second display demonstrates currently available information that can be shown to physicians to guide them in selecting the best medication for their patients. With specific information as displayed below, the prescriber can see that under this patient’s pharmacy benefit Livalo will cost $80 for a 30-day supply or $160 for a 90-day supply. Knowing a patient’s copay allows the doctor to have a meaningful discussion about the drug’s cost and patient’s needs. 

Additional information on alternatives appears when other therapeutically appropriate drugs are available for a lower cost. In this case, two alternatives are available for a substantially lower price, saving the patient more than $50/month.


Figure 2


Additional drug pricing information can also be provided for patients who have not met their deductibles. 

This level of savings is realistic, even among generics. Our recent analysis of drug pricing revealed that variations in dose and form yield drastically different costs for some common medications. Communicating this information to physicians can save as much as $1,680/year (or more).


A Savings-Driven Solution for Reducing Prescription Spending

By equipping doctors with access to essential drug information like cost, plan coverage limitations, and preferred pharmacies, they can make more informed decisions when selecting prescriptions that best meet their patients’ clinical and financial needs. 

That’s where Benmedica’s team of seasoned eRx veterans comes in. 

  1. Using our advanced analytics and proprietary methodology, we evaluate claims data to determine areas where added information could reduce costs.
  2. Next, we supplement current formulary data with additional cost and relevant alternatives information and deliver it to physicians through established channels.

Since our solutions integrate with current electronic prescribing technology, over 90% of physicians can access better information within their current workflows today. There’s no additional software to install, technology to learn, or training to complete. In addition, better information can be added into the real-time prescription benefit check to further improve savings through consistent messaging.


The Role of Health Benefit Consultants in Lowering Prescription Costs

Health benefit consultants are uniquely positioned to help their clients save money on prescription spending. By educating employers on the current problem and available solutions, consultants can facilitate greater savings for both their clients and the members their clients cover.

We work with health benefit consultants to decide what solutions best fit your clients’ needs and how to most effectively implement them. You’ll have an opportunity to review the data supporting our recommendations to use in discussions with your clients. 


About Benmedica

We help employers, health plans, PBMs, and other drug cost risk-sharing entities lower prescription spending by providing doctors Rx pricing information at the point-of-prescribing. 

Our team leverages over 150 years of combined experience to equip doctors with the information that drives down prescription costs for payers and patients. Contact us today to arrange a claims-based opportunity analysis so that you can put your clients on the path to greater savings.