Clinical Excellence Isn’t Enough: Why Cost Must Be Part of Care

There are always risks and benefits to any medical intervention, and they are both clinical and financial. In today’s healthcare environment, a strong provider–patient relationship can minimize clinical risk and maximize therapeutic benefit, but it rarely addresses the financial dimension, raising important questions about whether cost should be part of treatment decisions and whether patients should be supported to act as informed consumers alongside those bearing financial risk. For long-term sustainability, the right drug for the right patient must deliver value for all stakeholders, with particular attention to patient adherence, since delayed initiation, avoidance, or rationing of therapy undermines outcomes and increases waste. This is where collaboration between benefits leaders and providers becomes essential, sharing information quickly to identify treatments that are not only effective and tolerable, but also financially sustainable and more likely to be adhered to. Evidence illustrates the opportunity: earlier access to biologic therapy in psoriasis is associated with a significantly lower risk of developing psoriatic arthritis, reducing downstream suffering and total cost over time (Miao et al., 2025), while among GLP-1 receptor agonists for type 2 diabetes, liraglutide and dulaglutide show similar kidney and cardiovascular outcomes compared with semaglutide, suggesting opportunities to align prescribing with cost-effective choices without sacrificing outcomes (Derington et al., 2025). In a marketplace where information flows rapidly through PBMs, EHRs, and patient smartphones, building bridges between providers and benefits leaders, and recognizing how formulary and utilization decisions shape care at the point of service, is critical to reducing waste and total cost of care.

Miao, K. L., Huang, M. Y., Guo, L., Lung, K., & Armstrong, A. W. (2025). Effect of biologic use on the development of psoriatic arthritis: A population-based study. Journal of the European Academy of Dermatology & Venereology. https://doi.org/10.1111/jdv.70167

Derington, C. G., Sarwal, A., Wei, G., et al. (2025). Liraglutide vs semaglutide vs dulaglutide in veterans with type 2 diabetes. JAMA Network Open, 8(10), e2537297. https://doi.org/10.1001/jamanetworkopen.2025.37297