The Future of Affordable Pharmacy Benefits

By Sharon Faust

Prescription drug costs are driving health care spending, and the trend is raising alarms.

Plans and plan sponsors are struggling to manage rapidly increasing pharmacy expenses, while patients face growing concerns about affordability and access to the medications they need.

As we confront these challenges, the question isn’t which tactic to use next. It’s how to create a sustainable pharmacy benefit model that serves payers and patients for the long term.

For us, affordability has never been just about finding the next workaround or cost-shifting tactic. It’s about creating solutions that improve access to medications while responsibly managing costs for plans, plan sponsors and the members they serve. We focus on addressing the underlying drivers of pharmacy costs and establishing long-term solutions that deliver sustainable value.

In many ways, we’re entering the next phase of pharmacy benefits. The old approaches, characterized by opaque pricing structures, misaligned incentives and fragmented patient experiences, are giving way to models designed around accountability and outcomes.

Navitus is shaping that future. Our commitment to transparency starts with our 100% pass-through model, which ensures that clients receive the financial value generated within their pharmacy benefit program. This approach aligns incentives and allows plans and plan sponsors to clearly understand where their pharmacy dollars are spent. Transparency is the foundation for sustainable pharmacy benefit management.

We have extended these principles to our cost-plus specialty pharmacy through Lumicera Health Services. Lumicera was built to address one of health care’s fastest-growing drug categories. By focusing on lowest net cost while maintaining high-quality patient care, Lumicera helps clients manage specialty spend without sacrificing clinical outcomes.

But affordability is about more than pricing models alone.

We maintain a relentless focus on trend management across our organization, constantly evaluating opportunities to lower costs while preserving access to clinically appropriate therapies. Our generic and biosimilar-first approach is a strong example. As biosimilars become available for high-cost specialty medications, we work with clients, providers and members to encourage adoption when clinically appropriate. These therapies can generate meaningful savings while maintaining the quality of care that members expect and deserve.

We also know that every prescription represents a person. Our pharmacists and care teams provide high-touch support to help members navigate complex therapies, improve adherence and achieve better health outcomes. By managing the total cost of care, not just the cost of a drug, we can create lasting value for both clients and members.

The challenges facing pharmacy benefits are real. Drug prices continue to rise. Innovation brings increasingly complex and expensive therapies to market. Plans and plan sponsors are under tremendous pressure to balance affordability with access. Access matters, of course, because a benefit does no good if a member can’t afford the premium to be on it.

There’s no single solution to the issues confronting pharmacy today. But multiple meaningful solutions can and are making a difference.

We’re doing that now with our clients, serving organizations willing to embrace transparency, align incentives, prioritize clinical excellence and pursue sustainable strategies on cost and care. No quick fixes. But instead, lasting solutions that deliver lasting value.

At Navitus, that’s always been our approach.