The Hidden Costs of Pharmacy Spend: Why Outcomes Should Matter More Than Rebates

When looking at the value and return on investment in pharmacy benefits, it’s easy to get caught up in drug pricing, incremental costs, rebates, and quarterly spend trends. However, for more informed investing, we must also apply a PROACTIVE CARE lens — comparing downstream medical claims and utilization between those taking a drug and a matched cohort who are not. Are we putting up authorization barriers to costly brand and specialty drugs, saving in the short term, but inadvertently driving prescribers and patients toward more easily accessible options like opioids? Could we be increasing downstream medical costs related to substance use disorders — or even mortality rates — as a result? (Soo Ahn et al., 2025). Similarly, are we cutting spend on GLP-1 receptor agonists without considering that their use may reduce hospitalizations for conditions like recurrent atrial fibrillation, thereby lowering overall healthcare costs and improving outcomes? (Lou, 2025). Prudent pharmacy investment requires not just cost-containment strategies but ones that improve outcomes. Integration of medical and pharmacy data around matched cohort comparisons can inform more comprehensive and impactful decision-making.

Soo Ahn, S., Han, M., Jung, I., & Kim, C. Y. (2025). Association of oral opioid usage and mortality in patients with inflammatory arthritides: A Korean nationwide cohort study. Rheumatology. https://doi.org/10.1093/rheumatology/keaf135

Lou, N. (2025, April 26). GLP-1 Med Users See Drop in Recurrent Afib Events – Findings observed after ablation in Afib patients with T2D, obesity in large retrospective study. MedPage Today. https://www.medpagetoday.com/meetingcoverage/hrs/115297