What Your Members Are Telling You—Without Saying a Word

Scripta
Jul 24
2 min read

Understanding member behavior during your mid-year pharmacy benefits review

We’re halfway through 2025, and most plan sponsors are reviewing how their pharmacy benefit strategy is performing. Claims and rebates will tell part of the story—but your members’ behavior tells another, equally important one.

Members are constantly “voting” with their actions: What medications do they abandon? Where do they search for pricing help? Are they filling scripts on time—or not at all?

Recent data suggests this silent feedback is growing louder:

GLP‑1 abandonment remains high. According to data published by AJMC, 17.3% of approved GLP‑1 prescriptions were abandoned at the pharmacy through October 2024, down from 28.5% in 2023—but still among the highest for chronic therapies. These figures reflect approved claims, meaning true pharmacy abandonment may be even higher when denied claims are included.
Employers are highly focused on rising pharmacy costs. In its 2025 Health Care Strategy Survey, the Business Group on Health found that 76% of large employers are “very concerned” about pharmacy spend, and many cite affordability challenges tied to weight loss drugs and specialty therapies.

These signals reveal a persistent gap between benefit design and member behavior. While employers are seeking ways to manage rising drug costs, many members are quietly opting out of treatment altogether—often without the tools or information they need to navigate their pharmacy benefits effectively.

Scripta Tips: Mid-Year Action Plan for Plan Sponsors

To ensure your pharmacy strategy stays aligned for the second half of 2025:

Analyze member abandonment trends: Focus on high-cost and high-impact drug classes (GLP-1s, specialty meds, ADHD meds).
Track drug searches and pricing behavior: What are members looking for that isn’t covered or is too expensive to fill?
Audit usability and awareness of your transparency tools: If members aren’t using them, it may be a communications or design issue—not a lack of need.
Reinforce alignment between benefit design and member experience: Ensure that your plan promotes clinically sound, cost-effective options that members can actually access.

The takeaway: Your pharmacy data tells you what members did.Their behavior tells you why—and what to fix next. Are you ready to do something about it?