Snezana Mahon, PharmD, President, Transcarent
Employers are facing a universal issue: prescription costs. They now consume more than a quarter of the average annual healthcare benefits budget 1. With new therapies and GLP-1 demand surging to record highs, those costs are only headed higher.
As a result, many employers have started to move towards transparent pharmacy benefit managers (PBMs) that can deliver greater savings without limiting prescription access. We’re proud of the results Transcarent Pharmacy Care has delivered to date, both through our lowest net cost philosophy and the unique Member experience we provide that guides better medication decisions in real-time.
But the truth is, you can have the best rebate structure, the broadest access, and more therapy options than anyone else, and your consultant will still advise you to plan for double-digit percentage increases in your pharmacy spend next year. That’s a problem when more than half of working Americans say they worry about being able to afford their medications2.
The heart of the matter isn't about rebates or formularies; it's about instantly connecting people to the information, choices, and the clear price data they need in real time. The current system treats the pharmacy as the last stop in the benefits journey, instead of a powerful lever for better, more affordable care. But when Members get the right guidance at the right time, they make better medication decisions. And better decisions mean better outcomes and lower costs for everyone.
Now is the Time for a Pharmacy-Forward Benefits Strategy
Historically, benefits programs have treated prescriptions as an isolated, final step in the healthcare journey. But this approach fundamentally misunderstands how people actually experience care.
Think about pharmacy experience today: you’ve been taking a rheumatoid arthritis medication for years, but it stopped working. Your doctor prescribes something new on Friday afternoon. You only find out it’s not covered when you arrive at the pharmacy counter, where you face a choice between paying hundreds, even thousands, out-of-pocket, or going without a needed medication.
In that moment, most people don’t have the background (or the time) to ask: What’s the lowest plan price for a network-approved alternative? Are there prior authorizations? Which pharmacy can fill it this weekend?
Without timely, informed guidance, even the best-negotiated rebate or widest network won’t prevent avoidable costs or care delays. Spending still surges if people are forced into making last-minute, uninformed choices.
Transcarent Pharmacy Care flips that sequence. We take a different approach with pharmacy-forward care experiences that integrate pharmacy benefits into the earliest stages of care decision-making and give people actionable insight, including approved prescription alternatives, before a prescription is even sent to the pharmacist.
Why Place Pharmacy at the Center of a Benefits Strategy?
Instead of treating pharmacy benefits as an afterthought, they should be placed at the center of a benefits strategy. At Transcarent, that’s exactly the model we’ve built—one that meets people earlier in their care journey and helps employers manage costs across the entire ecosystem.
Here’s what that looks like:
Full prescribing oversight with integrated pharmacy & medical benefits
Our Members have access to one connected ecosystem with complete oversight of prescription fulfillment. Claims are monitored and issues are resolved quickly. We proactively surface lower-cost alternatives, whether brand, generic, or biosimilar. Every prescription becomes a touchpoint to connect Members with other benefits, from preventive screenings to behavioral health support.
Real-time guidance at the point of prescribing
New technology empowers our Members to make better decisions by showing them lower-cost options before their prescription is finalized, eliminating surprises and overpayment at the counter. Our AI-powered Care Assistant instantly answers medication questions, resolves benefit issues on the spot, and keeps treatments moving without unnecessary delays.
Transparent pricing with nothing to hide
We return 100% of rebates, use no-spread pricing, and charge a simple administrative fee we put fully at risk. There are no hidden costs, only lowest-net-cost strategies designed to save employers millions each year.
Transcarent Pharmacy Care: Rooted in Employer and Member Impact
Transcarent Pharmacy Care is designed around getting people the care they need rather than restrictions, and the gains are immediate and measurable.
Our model also removes the conflicts of interest that can create legal and financial risks for plan sponsors, helping employers meet their fiduciary responsibility, and aligning incentives with better outcomes.
With one place to go for all of their benefits and care, our Members can consistently find ways to save money on their prescriptions and receive support throughout their care journey.
Cost-saving alerts to help save money.
Prior-authorization notifications that prevent delays and reduce frustration.
Managing family medications and requesting refills are easy, and immediate, 24/7 support is available for any needs that arise.
Most importantly, Members are far less likely to abandon their prescriptions due to cost or confusion. When people can afford their medications and understand how to access them, they're more likely to stay on therapy—leading to better health outcomes and lower total healthcare costs.
The Way Forward with Transcarent
The pharmacy benefits landscape is at a turning point. Innovative approaches that put Member experience and connected care at the center are proving they can deliver both better outcomes and sustainable cost management.
For benefits leaders ready to move beyond the traditional approach and rethink their pharmacy benefits strategy, the path forward is clear. It starts with demanding transparency, insisting on Member-centered design, and partnering with organizations that align their success with yours. That’s what Transcarent Pharmacy Care is designed for, cutting expenses while giving Members greater prescription access, confidence, and continuity of care. Here's how to get started:
Attend our on-demand webinar where I take a deep dive and share action steps.
Watch for our action guides to help employers and consultants evaluate pharmacy benefits.
Connect with us for a personalized cost-savings analysis.
Because at the end of the day, your pharmacy benefits should work for you—not the other way around. When they're designed around getting people what they need, transparency, and genuine Member support, they become a competitive advantage rather than a sunk cost.
Sources
2025 Employer Health Care Strategy Survey, Business Group on Health, August 20, 2024. https://www.businessgrouphealth.org/resources/2025-employer-health-care-strategy-survey-executive-summary
“Prescription costs a burden for two-thirds of Americans, survey finds,” July 1, 2025, Benefits Pro. https://www.benefitspro.com/2025/07/01/prescription-costs-a-burden-for-two-thirds-of-americans-survey-finds/.
This article is not a substitute for professional medical advice. Always seek guidance from a physician or qualified provider regarding medical conditions.
