Why pharmacy deserves a year-round management strategy

Pharmacy can become one of the most consequential health-plan decisions because it combines utilization, clinical outcomes, specialty-drug access, manufacturer incentives and contract terms. A low pharmacy score is not a prompt to immediately change vendors. It is a prompt to understand what the current arrangement is designed to produce.

Begin in the Diagnose phase by creating a usable view of pharmacy spend and utilization. Separate specialty-drug spending from traditional pharmacy, identify the therapies and sites of care behind major changes, and clarify what data the employer can access. The goal is a management view that leadership can revisit—not a one-time renewal exhibit.

In the Design phase, test whether the plan’s clinical rules, formulary choices, member support and vendor incentives work together. Ask how specialty medications are sourced, how prior authorization is applied, where rebates flow and whether employees have a clear path to clinically appropriate, cost-conscious care.

Then make pharmacy part of the organization’s recurring governance rhythm. Establish the measures leaders will review, the decisions each report should inform and the contract commitments that hold partners accountable. That discipline turns a recurring Score priority into a practical healthcare-purchasing capability.