Benefit Pros Want to Know. We’ve Got the Answers.

Scripta
1d
5 min read

The pharmacy benefits landscape is shifting faster than ever. Between policy changes, new market dynamics, and breakthrough medications, benefits leaders are navigating unprecedented complexity. Here are the top questions we're hearing from plan sponsors – and the answers you need now.

Q: How will TrumpRx affect our pharmacy costs and benefit design?

A: TrumpRx could reshape the prescription drug landscape in three significant ways. First, by tying U.S. drug prices to international benchmarks, it may create downward pressure on what you pay at the pharmacy counter. Second, a new federal marketplace for direct-to-consumer purchases could give your members more options outside traditional PBM channels. Third, increased transparency requirements around PBM arrangements mean you'll need clearer visibility into rebates, spread pricing, and actual net costs.

The key for plan sponsors is proactive adjustment. This means reviewing your current benefit structures, ensuring your vendor contracts align with new transparency standards, and preparing member communications that explain how these changes affect their coverage. Scripta provides real-time visibility into drug spend and helps identify where policy shifts create actual savings opportunities—not just noise.

Q: Should we be steering members to cash-pay options, and how do we explain this without undermining our plan?

A: Cash-pay isn't about steering members away from coverage—it's about helping them navigate every path to affordable medication. The reality is that for many generics and some biosimilars, paying cash through discount cards or manufacturer programs can cost less than insurance copays. But most members don't know when this makes sense, creating confusion and eroding trust in the benefit.

Your opportunity is to lead with transparency. Help members compare insured and cash-pay pricing in real time, educate them in plain language about their options, and empower them to make informed decisions with their physicians. This isn't undermining your plan—it's demonstrating that you're genuinely working in their best interest. When members see you're not hiding the ball on pricing, trust increases.

Q: We work closely with our benefits consultant – how do we know a new vendor won't create more headaches than solutions?

A: The implementation phase is where most vendor relationships either build trust or create friction. Smart plan sponsors evaluate potential partners not just on what they deliver, but on how smoothly they get there.

The real costs of vendor friction are often invisible until you're in the middle of it: drawn-out contract negotiations, unclear timelines, data-sharing delays that push implementations by months, and finger-pointing between your consultant, PBM, and new vendor. These aren't just annoying—they're expensive, and they erode confidence in the decision.

At Scripta, we’re all about eliminating “FUD” (fear, uncertainty and doubt) and create a streamlined experience for clients through:

White-labeled contracting: Scripta minimizes paperwork and accelerates contracting timelines. This approach allows clients to work directly through their trusted consultant while still benefiting from Scripta’s solutions, making the path from interest to implementation faster and more seamless.
Proven implementation process: Scripta clients report 100% satisfaction with our implementation process—not because we promise perfection, but because we've built repeatable systems that work regardless of how your consultant is involved.
Global Data Sharing Agreements: Scripta maintains Global DSAs with many of the PBMs, including the "Big Three." These established agreements allow for faster, more reliable delivery of critical data such as claims feeds and eligibility files, streamlining communication and reducing back-and-forth during setup.

The difference between a three-month implementation and a nine-month one often comes down to whether these foundations are already in place. When they are, you move from contract signature to member impact in weeks, not quarters—and your consultant relationship gets stronger, not more complicated.

Q: What's our strategy for GLP-1s: cover them, don't cover them, or something in between?

A: GLP-1s present both a clinical opportunity and a cost challenge. These medications can cost $900–$1,300+ per month at list price, but manufacturer direct programs and cash-pay options can drop that to $349–$499+.

The cost of doing nothing is significant: members with obesity or high cardiometabolic risk typically generate $500+ more per member per month in medical spend compared to lower-risk populations.

Scripta supports self-funded plan sponsors by delivering custom GLP-1 navigation and access orchestration, minimizing friction and cost:

Member Navigation & Education: We help members understand what their employer offers, walk them through next steps, and clarify tradeoffs (plan coverage vs cash-pay).
Access Pathways & Cash Pay Integration: For sponsors not covering GLP-1s, we route eligible members to direct-to-consumer options, cash pay, and copay assistance while tracking cost impact.
Savings via Optimization: By smoothing access and identifying lower-cost channels, we drive measurable savings while maintaining or improving adherence and member satisfaction.

Your strategy should start with five strategic pillars:

Quantify demand: Analyze how many members currently use or might qualify for GLP-1s based on BMI and comorbidities (Scripta Insights)
Evaluate PBM dynamics: Review formulary placement, prior authorization requirements, and rebate structures (Scripta Insights)
Define your coverage stance: Decide whether to cover GLP-1s for weight loss, diabetes only, or cardiovascular risk—and communicate it clearly (Scripta Insights)
Embed navigation support: Help members understand their options, whether through insurance, cash-pay, copay assistance, or manufacturer programs (Scripta Insights)
Stay agile: The GLP-1 space evolves rapidly with new pricing models and therapies emerging regularly (Scripta Insights)
Consider shared savings programs: Look into providing incentives for members who choose the most cost-effective GLP-1 options. The goal is to give members access while maintaining cost sustainability.

Q: With pharmacy now representing 27% of our total health spend, how do we start building a smarter 2027 strategy?

A: You're right to focus on 2027 now. Pharmacy is no longer a quiet corner of your health plan — it’s where the action (and the spend) is. Between GLP-1s, specialty drugs, and site-of-care shifts, the next few years will define how sustainable your benefits strategy really is. According to Willis Towers Watson, 9 in 10 employers now say rising benefit costs are a top business issue — nearly a 25-point jump since 2023. At the same time, nearly two-thirds plan to rebalance their benefits budgets in the next three years.

Translation: it’s not about spending more, it’s about spending smarter.

Pharmacy is already at the center of that rethink. The Business Group on Health reports that pharmacy’s share of total health spend jumped from 21% in 2021 to 27% in 2023, and it’s still climbing. Without new strategies, pharmacy costs could rise another 10–11% this year alone.

So how do you get ahead of it? Start building your 2027 Rx playbook now — and focus on the levers that matter most.

Your 2027 Rx plan doesn’t have to be perfect — just intentional. Scripta helps employers model GLP-1 impact, stress-test specialty exposure, and find savings hiding in plain sight. Let’s start building the roadmap now so you’re ready for what’s next -- without changing PBMs!