Why Your Rx Cost Containment Strategy Isn't Keeping Up — and What to Do About It
- Scripta
- 4 days ago
- 5 min read
Pharmacy costs are climbing — and for most HR and benefits teams, the usual playbook of Rx cost containment strategies isn't doing enough to keep up. In a recent conversation with Jordan Counts, VP of Pharmacy Services at Quantum Health, we got into the weeds on why that is, and what a more effective approach looks like.
The real problem isn't your benefits plan — it's what happens after it's designed.
Most employers have put serious work into their pharmacy benefits: better PBM contracts, specialty drug programs, prior authorizations, formulary design. And costs still keep rising. That's not because the work doesn't matter. It's because all of those decisions get made at the plan level — before a single prescription is written.
What happens next is largely out of employers' hands. A doctor writes a prescription in an 8-minute appointment, usually without knowing what the drug costs. A member takes that script to the pharmacy and finds out at the counter — often for the first time — what they owe. About 30% of the time, they can't afford it and leave without the medication.
Nobody in that chain made a bad decision on purpose. They just didn't have the right information at the right moment. That's the gap — and it's where pharmacy spend quietly bleeds out, no matter how thoughtfully the benefit was designed.
Knowing prices exist and knowing which price to use are two different things.
The industry talks a lot about "transparency" in drug pricing. And while having pricing information available is better than not having it, transparency alone doesn't tell a member what to actually do — and the GLP-1 category is a perfect example of why that matters.
Take Zepbound, a popular weight loss medication. Depending on how a member accesses it, the price could be anywhere from $25 to over $1,000 — for the exact same drug. Pay through insurance with a copay card? $25. Pay cash with no assistance? Over $1,000. Use the manufacturer's direct program? Around $300. So many different price points, yet most members have no idea any of the cheaper options exist.
Here's the part that hits hardest for employers: even when a member thinks they're getting a good deal, the employer could still be absorbing thousands of dollars in annual costs depending on which pathway ran through the benefit. Transparency tells people prices exist. What members actually need is someone — or something — that looks at their specific situation and says, “Here's the option that's best for you and your plan.” That's guidance, and it's a fundamentally different capability.
There's significant savings in the medications your members take every day — not just the expensive specialty drugs.
When pharmacy costs come up, the conversation usually jumps straight to specialty medications — the high-cost drugs for complex conditions that show up at the top of every claims report. That attention is warranted. But specialty drugs represent about half of total pharmacy spend, which means the other half tends to get overlooked.
That other half is maintenance medications — the blood pressure pills, cholesterol drugs, antidepressants, and other prescriptions your members refill month after month without a second thought. These drugs are full of savings opportunities that rarely get surfaced. In many cases, a member is paying for a brand-name drug when a clinically equivalent generic or alternative exists at a fraction of the cost — and neither the member nor their doctor has ever had that conversation.
Scripta has mapped 17,000 drugs to every available savings option, with each recommendation reviewed by a panel of more than 25 actively practicing physicians for clinical oversight. Across hundreds of thousands of medication switches, Scripta clients have saved over $100 million — much of it from exactly these everyday medications that other solutions may never look at.
Savings guidance only works if it actually reaches people — in a way they'll use.
The best clinical analysis in the world doesn't save anyone money if it sits in a report that nobody reads. What makes the partnership between Scripta and Quantum Health meaningful is where and how the guidance gets delivered.
Quantum Health is the navigation platform that many employers use as a "front door" to healthcare — it's the app members open, the number they call when they have a benefits question, the service that helps them figure out what's covered and what to do. Integrating Scripta's pharmacy savings intelligence into that experience means members see their specific savings opportunities in the app they're already using, in personalized mailings, and in conversations with Quantum's Care Guides when they call in.
Providers aren't left out either. Our personalized pharmacy navigation can send member-specific recommendations directly to a prescriber within their workflow — so when a physician is deciding what to prescribe, they have the information they need to make a cost-conscious choice without doing their own research.
The key word throughout the conversation was personalized. Not "here are some ways employees can save on prescriptions generally." Here is your employee, on this medication, with this plan — and here is the specific option that saves them the most money. That level of specificity, delivered through channels people actually engage with, is what turns good information into real behavior change.
This isn't a one-time fix — it's an ongoing need.
Here's a stat worth sitting with: 70-80% of pharmacy spend every year comes from maintenance medications being refilled over and over again. That means the majority of what your plan spends on pharmacy isn't dramatic or unpredictable — it's the same people, filling the same prescriptions, month after month.
The implication is that a one-time communication campaign or a single open enrollment nudge isn't going to move the needle for long. The opportunity is continuous — and so the solution needs to be too. What changes costs over time is members consistently having access to personalized guidance whenever they're making a pharmacy decision: when a new prescription is written, when a refill is due, when a drug's price changes, when a new lower-cost option becomes available.
That's what a pharmacy navigation layer is built to do. It's not a report. It's not a one-time audit. It's an ongoing system that makes sure every prescription decision — for every member, across every medication — has the best possible information behind it.
Want to know all the details? Click here to watch our full conversation with Quantum Health – available now on demand. Together, we break down how employers can move beyond traditional Rx cost containment strategies and better support members while managing rising pharmacy spend.