Pharmacy Savings Shouldn’t Come at the Employee’s Expense

Our work with this client focused on three connected moves.

First, we helped manage GLP-1 utilization in a focused way. The goal was not to block access. It was to make sure approvals matched the benefit design and that the right members received the right therapy.

In the second half of the year, 533 GLP-1 prior authorization reviews were completed. 62% were approved, and the plan avoided $204,000 in off-label spend.

That is what the right pharmacy benefits partner should do: create clear guardrails without putting unnecessary barriers between people and the medications they need.

Second, LucyRx Care Guides helped members directly.

LucyRx Care Guides are clinical support teams, including registered nurses, clinical pharmacists, and certified pharmacy technicians, who work one-on-one with members when prescription care gets complicated. They help people find copay assistance, identify lower-cost options, and understand next steps for complex therapies.

For many employees, the hardest part of managing a chronic condition is not the diagnosis. It is everything that comes after.

Over six months, LucyRx Care Guides supported 7,510 cases and engaged 1,874 members. Their work helped deliver $1.91 million in plan savings and $457,000 in member savings, for $2.37 million in combined plan and member savings.

That is not just service. It is a performance lever. When people get real help, plans perform better.

Third, we helped execute a biosimilar strategy.

Biosimilars can be one of the clearest opportunities in pharmacy, but only when the transition is managed with care. In this case, the plan had 10 members using Stelara. Seven transitioned to biosimilars, and the remaining members moved to appropriate alternatives.

The result was $235,000 in savings and no Stelara claims entering 2026.