A regional, not-for-profit health plan had a clear mission: improve member health outcomes while delivering a pharmacy experience that felt personal, transparent, and aligned with local values. As healthcare costs rose and member needs became more complex, the plan recognized that its traditional pharmacy benefit no longer supported that mission.
The health plan wanted greater control over its pharmacy benefit—control that would allow it to prioritize member experience, clinical outcomes, and community relationships rather than rely on one-size-fits-all solutions. They were committed to keeping care local by supporting regional pharmacies and providers that members already knew and trusted. Flexibility and customization were essential to designing benefits that reflected the plan’s unique population and long-term goals.
To achieve this, the health plan partnered with the NeosRx team to implement a customized pharmacy benefit model. This approach provided direct visibility into pharmacy utilization and trends, enabling clinical and care management teams to make more informed, proactive decisions. Formularies, programs, and policies were tailored to support medication adherence, chronic condition management, and equitable access to care.
Members quickly began to see improvements. Clearer communication, fewer barriers at the pharmacy counter, and locally rooted pharmacy networks helped reduce confusion and frustration. Because programs were designed around the needs of the population, members received more relevant support, including targeted outreach for high-risk conditions and benefit designs that reflect real-world medication use.
Enhanced Member Experience
Members experienced clearer communication, fewer barriers at the pharmacy counter, and stronger access through locally rooted pharmacy networks. Programs tailored to the population provided more relevant support, including targeted outreach for high-risk conditions and benefit designs that reflect real-world medication needs.
Value Aligned With Values
NeosRx’s customized approach aligned with the health plan’s people-first mission by reinvesting resources into member support, clinical programs, and community partnerships instead of pharmacy benefit revenue. Local pharmacies became trusted care partners, improving coordination and member relationships.
Together, NeosRx and the health plan also developed a Value Preventive Drug List that eliminates cost sharing for many preventive medications. Going beyond Affordable Care Act requirements, the program expands access to treatments for mental health, cardiovascular and respiratory conditions, diabetes medications, and supplies—helping members receive essential care without unnecessary financial barriers.
The NeosRx team worked closely with this health plan to implement cost-reduction strategies. Together these efforts brought the health plan’s per member drug spending down by 32%.
“Members shouldn’t have to decide between paying for their prescriptions or paying their rent.”
Health Plan CEO
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