The CFO Case for Care Guides: From Cost Pressure to Controllable Results

  • 3 Min read

  • November 25, 2025

Tammy Beeson

Tammy Beeson

Vice President, Patient Advocacy Care
Best Practices
CFO Case for Care Guides

I’ve spent enough time with employees to know the hard moments aren’t abstract. They’re a missed refill before a big presentation. A specialty start that stalls. A surprise bill that makes someone think about skipping a dose. As leaders, we owe people help that actually helps—and we owe the business results we can explain.

Health benefits are one of your largest operating expenses, and you’re accountable for both outcomes and experience. Costs continue to climb—+5.8% expected in 2025 [1]—and specialty drives a growing share. You need a lever that works now, with clear accountability.

If you can’t see the PMPM and measure the outcomes,
it’s not a lever—it’s a hope.

What we mean by “Care Guides”

LucyRx Care Guides are licensed nurses, pharmacists, and certified pharmacy technicians who provide one-to-one support at the moments that most often derail therapy. They help members start and stay on treatment by coordinating with prescribers and pharmacies until specialty therapy is active and scheduled, lining up refills, enrolling eligible members in manufacturer copay support and patient assistance programs, and providing clear education about what to expect—so people feel confident and stay on track.

Where the waste hides

Here’s where good people fall through the cracks—and where guided help changes outcomes.

  • Nonadherence. Missed refills and drop-offs drive avoidable downstream medical costs—still $100–$300B annually in the U.S. [3].
  • Affordability confusion. Employees who don’t know their options choose costly paths—or forgo therapy.
  • Biosimilar transitions. Savings are real only when members and providers switch with confidence (national savings show the headroom) [2].
  • Operational friction. Specialty starts, pharmacy changes, and supply issues can derail adherence without high-touch guidance.
Generics + biosimilars: $467B savings in 2024; biosimilars $20.2B alone [2].

What LucyRx Care Guides change

  • Proactive outreach after new specialty starts or therapy changes.
  • Coordination with prescribers and pharmacies until therapy is active and scheduled.
  • Affordability activation: manufacturer copay and  Patient Assistance Programs
  • Clear education on “what to expect,” so members stay on therapy.
  • Named accountability—one clinician who closes the loop.

Our goal is simple: keep people healthy and working, then let the savings follow.

A simple CFO mini-model (illustrative)

Assume 8,000 covered members.

  • Program cost: Care Guides Plus $5.00 PMPM → $40,000/month → $480,000/year.
  • Conservative savings drivers:
    1. Adherence lift in targeted chronic and specialty cohorts (reducing avoidable acute spend) [3].
    2. Biosimilar adoption where clinically appropriate (capturing PMPM savings demonstrated in national data) [2].
    3. Affordability enrollment (copay/PAP) to prevent drop-offs.
    4. Continuity coordination during specialty onboarding and supply disruptions.
  • Back-of-the-envelope: Capturing $15–$25 PMPM across identified cohorts yields $1.4–$2.4M annual pharmacy savings before medical offsets—supporting a 2.5–3.0:1 ROI in many settings. † Actuals vary by mix and baseline.

Healthy people drive healthy numbers.

Why this works financially

  • It targets high-friction, high-cost moments, not broad, expensive programs.
  • It’s transparent: PMPM pricing, defined scope, monthly outcomes (time-to-therapy, adherence, gaps in treatment, biosimilar adoption).
  • It scales across conditions and plan designs without adding a new vendor stack.

LucyRx Care Guides pricing:

  • Care Guides — $3.50 PMPM
  • Care Guides Plus — $5.00 PMPM

Typical outcomes include $10–$12 PMPM savings and 2.5–3.0:1 ROI across covered populations.† We put it in writing and track it.

We can care about people and the P&L at the same time. Help employees in the moments that matter—and watch the numbers move.

Move from pressure to controllable results.

Schedule an ROI walk-through with one of our experts.

Contact Us
Sources
[1] Mercer. “Employers expect third consecutive year of health benefit cost increases above 5% in 2025.” Sept 12, 2024.
[2] Association for Accessible Medicines (AAM) & IQVIA. U.S. Generic & Biosimilar Medicines Savings Report (2025) — $467B in 2024 savings; biosimilars $20.2B.
[3] Recent reviews on U.S. medication nonadherence costs — commonly $100–$300B annually (e.g., Therapeutic Advances in Drug Safety, 2025; Biomedicines, 2025).


† Outcomes measured using plan claims over a defined baseline and measurement period; results vary by population mix, adoption, and plan design.

Tags

Care Guides CFO case for care guides PMPM savings employers Reduce specialty drug costs

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