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Turning Pharmacy from a Cost Center into Guided Care
Turning Pharmacy from a Cost Center into Guided Care
Pharmacy data is one of the most powerful and underused sources of insight in healthcare. A prescription provides a real-time window into a person’s health, whether it is a new antidepressant, a GLP-1, or an oncology therapy. Each represents a critical moment to offer an individual more support and care.
Yet for most employers, this rich stream of data shows up only as rising pharmacy spend. The opportunity is to use pharmacy data not just to see costs, but also to help people make better decisions about their health and care.
That’s why we connect this pharmacy and health data together in a model we call pharmacy-led navigation. Each prescription provides insight into a person’s health and can be transformed into guidance and support for the best next step, including where to go, what to pay, and what to do next across the care journey.
From Standalone Pharmacy Benefit to Connected Experience
At Transcarent, pharmacy-led navigation is integrated by our transparent PBM partners directly into the agentic AI-powered WayFinding™ platform. Our Members — and the doctors, nurses, and therapists who treat them — see the same information in One Place™, and every pharmacy interaction can connect to the next-best action across the rest of their benefits and care journey.
The result is simple: pharmacy stops being a black-box cost center and becomes a data-rich entry point to better care experiences, improved outcomes, and smarter spend. For employers, that shift delivers three core outcomes: transparent drug pricing and more options, stronger connections to the right care for their people, and better cost and health outcomes.
1. Clearly Surface Lower Pricing and Drug Options
One of the most important functions of pharmacy-led navigation is helping people clearly understand and act on better options for their medications. When a prescription is written, Members get a simple and easy-to-understand view of their options to help them shop for better prices and choose the best pharmacy to meet their needs. Within the Transcarent experience, Members will see options for:
Different pharmacies and fulfillment channels, such as their local pharmacy, at-home delivery, or a 90-day supply, with out‑of‑pocket costs clearly displayed.
Lower‑cost, clinically appropriate alternatives when they are available.
Opportunities to move from out‑of‑network or high‑cost sites of care to more affordable options.
And guess what? When people have accurate, transparent information at their fingertips, they make great choices. Across our pharmacy experience, we see that 43% of Transcarent Members find a lower‑cost pharmacy option for their medications1 and are connected to the right programs and providers when they need more than a refill. That’s immediate, measurable savings on decisions that were already happening.
2. Pharmacy Signals Guide People to the Right Care
When pharmacy and medical data are integrated, each prescription becomes a trigger to connect people to the right care at the right time. For example:
A new antidepressant can prompt a proactive nudge: “You just filled a prescription for depression. You also have a mental health benefit—would you like to connect with a therapist or see virtual care options?”
A GLP‑1 prescription can guide the Member into our comprehensive Weight Health program that combines medication with coaching, monitoring, and long-term lifestyle support.
A new oncology therapy can surface our Cancer Care experience, helping the Member understand benefits, coordinate second opinions, and connect to a specialized care team.
These touchpoints are not generic messages. They are triggered by real-time data and delivered through coordinated outreach, backed by a 24/7 Care Team and an AI-powered experience that can answer questions, close gaps in understanding, instantly connect people to care, and remove friction at each step.
3. Save Money and Improve Health Outcomes
When Members save money on prescription costs, they continue to return to Transcarent, using more of the benefits offered by their employer. On the health side, the connected experience drives deeper Member engagement and more consistent follow‑through, demonstrated with results like:
20%+ higher benefit engagement1.
On the cost side, transparent, auditable pharmacy economics are paired with real‑time decision support. That means:
Members have the choice to move toward lower‑cost, clinically sound options instead of defaulting to the most expensive choice.
High‑cost therapies are aligned to programs that ensure they are used appropriately and supported over time.
Avoidable waste, such as unnecessary refills, duplicative medications, or sub‑optimal sites of care, can be identified and addressed.
Together, these results show how pharmacy-led navigation can create meaningful change: every prescription becomes a moment that guides Members into a more comprehensive care experience. Employers gain greater control over where pharmacy dollars go and how real-time decisions are shaping outcomes and total cost of care.
Pharmacy benefits are a critical piece of a person's health journey, and account for a large portion of an employer's healthcare spend. Solving pharmacy spend isn’t about more reports; it’s about better decisions made in the moment. That’s what pharmacy‑led navigation is designed to do.
¹Transcarent book of business results.
