Five Tips to Turn Midyear Rx Findings Into Measurable Results

A midyear benefits review can surface a familiar mix of findings: prescription spend is running ahead of forecast, a small number of medications are driving a disproportionate share of cost, or members are not moving to lower-cost options already available to them.

Those findings matter only if they lead to action. The good news is that employers and health plans do not need to redesign the benefit, replace the PBM, or wait until January to begin improving results. With the right Rx intelligence and focused member and prescriber support, there is still time to create and measure progress before year-end.

Close the gap between identified opportunities and realized savings

Many Rx strategies look promising on paper. Lower-cost, clinically sound alternatives may be available, and members may even receive information about their options. But identifying a savings opportunity does not mean the savings will be realized.

The gap often appears between revealing a lower-cost option and helping a member act on it. Members may not understand the recommendation, know how to discuss it with their doctor or feel comfortable changing a medication that is working. Prescribers may not have visibility into what a medication costs under the member’s plan or the clinical context needed to evaluate an alternative.

That is why a useful midyear review should look beyond the savings opportunities identified. It should examine where member action stalled, what created friction and what support could help members and their prescribers move forward with confidence.

Five actions you can take before year-end

Reassess the medications driving spend

Start with current claims rather than assumptions made during the last renewal cycle. Look for high-cost medications, changes in utilization and categories where clinically sound, lower-cost options may now be available.

The goal is not to conduct a broad formulary exercise. It is to identify the specific medications and members driving the clearest opportunities to reduce plan and member costs during the remaining months of the year.

Prioritize opportunities members can act on now

Not every opportunity offers the same financial value or requires the same level of support. Prioritize opportunities based on potential plan and member savings, clinical complexity, refill timing and the steps a member would need to take.

This turns a long list of potential savings into a focused action plan, while also helping your team direct support toward the opportunities with the greatest potential impact.

Give members a clear path to prescription savings

Simply showing members a lower-cost option may not be enough to prompt action. They need clear guidance that explains the opportunity, how it could affect what they pay and what to do next. Some may need help comparing pharmacy or cash-pay options. Others may need support discussing a medication alternative with their doctor.

Targeted pharmacy navigation can provide that support without changing the underlying benefit. It helps members understand their options and move forward with confidence, while keeping the final medication decision between the member and their physician.

Give prescribers useful clinical and cost context

When a savings opportunity involves changing medications, the prescriber needs to evaluate whether the alternative is appropriate for the patient. Outreach is more useful when it is concise, patient-specific and supported by credible clinical and plan-specific cost information.

A coordinated process can reduce back-and-forth among the member, Scripta and the prescriber’s office, helping physicians make informed decisions without compromising clinical judgment.

Measure completed action and what happens afterward

Engagement metrics can show that a member opened a message or viewed a recommendation. They do not confirm that behavior or pharmacy spend changed. Measurement should use claims to verify completed actions, calculate the resulting plan and member savings, and distinguish identified opportunities from realized results.

The work should continue after the first fill. Ongoing claims monitoring can show whether a lower-cost choice persists, whether therapy changes again and whether the expected savings are sustained. That is how an identified opportunity becomes measurable, lasting savings.

Start acting before the next plan year

If your review has uncovered rising pharmacy spend or missed savings opportunities, you do not necessarily need to wait for the next plan year to respond. With the right Rx intelligence and focused member and prescriber support, there is still time to begin turning those findings into action before year-end.

Off-cycle implementations are possible. Scripta’s Rx Navigation™ layers directly on top of your existing plan design, PBM and benefits ecosystem, without requiring a PBM change or benefits redesign. Its standard implementation window is approximately 90 days, allowing time to establish data sharing, develop member communications and prepare internal stakeholders for launch.

Once implemented, Scripta analyzes plan data to reveal clinically sound, lower-cost choices for members and actionable savings opportunities for plan sponsors. Members receive personalized savings options and support, while prescribers receive patient-specific clinical, formulary and cost information to help them make informed prescribing decisions.

The plan year may be underway, but your opportunity to improve Rx results is not over. The sooner identified opportunities become supported member and prescriber action, the sooner they can become measurable savings for your plan and your members.