Op-Ed: True PBM Transformation Starts with Pharmacists

Across the US, patients, providers, and employers continue to grapple with rising health care costs. The explosive growth of prescription drug costs has been a major accelerant to this persistent problem, with nearly 25% of every dollar Americans pay for health care premiums going toward prescription drug spending.¹

Fortunately, more affordable pharmacy care is not only possible but also within reach. The solution doesn’t require a full reinvention of the existing system but rather elevating health care professionals who are already deeply embedded in care delivery and trusted by patients: clinical pharmacists.

A growing number of mid-market pharmacy benefit management (PBM) companies are already empowering clinical pharmacists to operate at the top of their license to help improve patient health outcomes and lower drug spend. The goal is for clinical pharmacists to partner with prescribing physicians to advance a more informed, hands-on approach to medication management that strengthens essential pharmacy care by optimizing the patients’ drug mix.

The Evolving Role of the Clinical Pharmacist

Trained extensively in pharmacology, drug interactions, dosing, and therapeutic alternatives, pharmacists are highly trained in medication management. They are also uniquely positioned to use this training and expertise to provide more proactive medication recommendations as part of the pharmacy care process. With a deep understanding of medication efficacy, interactions, and safety risks, clinical pharmacists should play a much bigger role in managing and optimizing the pharmacy benefits programs that more than 180 million Americans rely on for their health care.

It starts with expanding the clinical pharmacist’s role in pharmacy care through the clinical review of medication therapies and direct collaboration with prescribers. By taking on a larger role in pharmacy benefits management, clinical pharmacists can help answer critical questions that significantly impact patient health, such as:

• Is the prescribed therapy the most clinically appropriate and cost-effective option for my patient?
• Is the dosage tailored to my patient’s full medication profile and medical history?
• Is there a safer or more cost-effective alternative treatment option?

Having the knowledge and ability to look holistically at a patient’s medication mix and answer these questions to make informed recommendations is critical to enhancing patient safety and health outcomes, while also driving more cost-effective, evidence-based treatment that meets patient needs.

Reimagining Care Teams Through Medication Optimization

Some next-generation PBMs have already built innovative new operating models around clinical pharmacists. Early adopters of this approach have seen success across patient health outcomes and overall cost savings. For example, EmpiRx Health clients experience an average 15% reduction in drug spending within the first year.²

At EmpiRx Health, we utilize a newly expanded pharmacist-led pharmacy care model, our Medication Optimization operating model—or “MO,” for short. This unique operating model relies on breakthrough technology available through the Clinically pharmacy care platform that analyzes member population health to provide data and recommendations for medication optimization. With access to data and insights, clinical pharmacists can more effectively stratify patients by risk and identify opportunities to intervene when they may benefit from alternative treatment options or changes to their existing medication regimen. Through MO, pharmacists and care teams can work directly with members who need high-touch care or have complex health conditions and could benefit from support.

With more comprehensive visibility into patient health data, including medication use patterns, clinical pharmacists who are involved throughout the pharmacy benefits management process can help optimize treatment regimens to improve the likelihood that clinically appropriate therapies are also financially sustainable.

The Future of Pharmacy Care

By giving clinical pharmacists a larger role in pharmacy benefits management, patients are more likely to receive the right medications, in the right doses, at lower costs.

The potential value of PBMs that adapt their models to use a pharmacist-led approach to care is significant, with data showing that over 20% of Americans have not filled a prescription medication due to concerns about affordability.³ As the PBM landscape evolves, operating models that leverage clinical pharmacists can help more effectively identify and address persistent challenges that impact patients, such as cost.

The question is no longer whether pharmacists should play a bigger role in health care but how quickly the current pharmacy benefits system can adapt to leverage their expertise. As some of the more innovative alternative PBMs continue to demonstrate, when pharmacists are positioned as trusted clinical partners, patients receive more personalized, clinically appropriate care. The future of pharmacy care is about more than filling prescriptions; it requires collaboration that puts patients' best interests at the center of each decision.

REFERENCES

1. Drug and hospital costs account for nearly two-thirds of Americans’ health care dollar. News release. AHIP. October 28, 2024. Accessed March 24, 2026. https://www.ahip.org/news/press-releases/drug-and-hospital-costs-account-for-nearly-two-thirds-of-americans-health-care-dollar

2. EmpiRx Health transforms the PBM industry again with launch of industry-leading medication optimization (“MO”) operating model. News release. EmpiRx Health. January 14, 2025. Accessed March 24, 2026. https://www.empirxhealth.com/empirx-health-transforms-the-pbm-industry-again-with-launch-of-industry-leading-medication-optimization-mo-operating-model/

3. Sparks G, Lopes L, Montero A, Presiado M, Hamel L. Americans’ challenges with health care costs. KFF. January 29, 2026. Accessed March 24, 2026. https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/