Every day, patients get caught in a maze of benefit designs, high-cost therapies, and confusing benefit rules. When clinical guidance and education for patients are missing, outcomes suffer and costs climb—avoidably.

Patients leave the physician’s office and hit a wall, with delays, denials, and prior authorizations blocking the care their doctor intended. Still others juggle multiple care providers with no nexus of information, ensuring mistakes or unintended reactions are avoided.

Polypharmacy risks are real—and they’re preventable. Nearly one-third of US adults take five or more medications, but too often, no one pays enough attention to the risks to sound the alarm. Adverse drug events—harm experienced by a patient because of exposure to a medicine—are among the most common preventable adverse events but each year account for nearly 700,000 emergency department visits and 100,000 hospitalizations.¹

Cost and access matter, but without education and support, a disjointed system fails patients.

This is where trained clinicians—built into the benefit—bridge the gap between complexity and human-centered care.

Clinical support

Pharmacy benefit managers (PBMs) should deliver value-based care through a renewed focus on the power of human connection. One way to do this is by providing one-on-one counseling and clinical support to patients. Ideally, these professionals providing support are trained nurses, pharmacists, or pharmacy technicians that are familiar with each member’s prescription history and are equipped to provide personalized guidance to help lower drug costs, secure approvals, improve health outcomes, and increase members’ understanding of their treatment.

With this model, patients can receive support on two levels: at the counter with their pharmacist and at the benefit level through their PBM. Both can have a meaningful impact, especially as direct-to-consumer options such as Mark Cuban’s Cost Plus Drugs and large e-commerce pharmacies begin to proliferate.

While these new programs are opening doors for patients by chasing big savings, they must be coupled with clinical guidance. Without it, patients are left to figure out on their own how these programs will integrate with their insurance. Employers who consider adding these alternative sourcing platforms should require their PBM to provide clinical support no matter where the script is filled.

The risk we run when we don’t give patients guidance is clear. If they can’t afford their medications, they won’t take them. If support is outsourced and “non-clinical,” patients lose trust and stop treatment.

No member should navigate treatment alone, and clinical support makes sure they don’t have to.

Improving outcomes

Patient support programs and clinical interventions have consistently been shown to improve outcomes across every stage of the healthcare journey.

One study found that pharmacist- and nurse-led interventions led to significant improvements in blood pressure control and medication adherence.² Another systemic review found that nurse-led interventions improved drug adherence and self-management and, in some cases, reduced hospital readmissions and mortality for those with multiple chronic conditions.³

Several high-quality systemic reviews also found that pharmacist- and nurse-led interventions—such as patient education, counseling, and simplifying dosing—improved medication adherence, patient satisfaction, and health outcomes. In many cases, these interventions were more effective than those delivered by primary care physicians.⁴

These findings prove that when patients receive one-on-one guidance, outcomes improve.

What’s the value of offering clinical navigation and support?

There are several ways these services add value for members:

• Simplify the path. From prescription to pickup, trained nurses, pharmacists, or pharmacy technicians guide members safely through every step.
• Empower with clarity. Clinical navigators decode benefits in
  plain language so members can make confident and cost-smart decisions.
• Financial coaching. Clinical navigators lower costs through manufacturer assistance, optimized benefit design, and evidence-based alternative sources—without compromising safety or compliance.
• Clinical continuity. A dedicated navigator educates, advises, and coordinates care so therapy stays on track.

A shift in prescription care

Prescription care is changing, and it’s up to benefits providers to reinforce the value of human connection in a complex system.

For those partners and solution providers in this evolving care journey, delivering one-on-one support to nurses, pharmacists, and pharmacy technicians that resolves barriers quickly and keeps members adherent to their therapies is key. For example, one new member shared that we are the first PBM to proactively reach out and find a specialty pharmacy for her son with hemophilia. Previously, she had been forced to switch pharmacies seven times to meet the demands of the PBM as opposed to what was right for her family.

No patient should navigate this alone. Let’s make prescription care unmistakably human and hold PBMs, including us, accountable for it.

Susan Thomas is Chief Commercial Officer at LucyRx

References

1. Medication Errors and Adverse Drug Events. Agency for Healthcare Research and Quality. December 15, 2024. https://psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events

2. Reeves, L.; Robinson, K.; McClelland, T.; Adeodoyin, C.A.; Broeseker, A.; Adunlin, G. Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials. J Pharm Pract. 2021. 34 (3), 480-492. https://pubmed.ncbi.nlm.nih.gov/32067555/

3. Ruksakulpiwat, S.; Pongsuwun, K.; Junphongsir, P.; Preeprem, C.; Nguantad, S.; Samart, B. NIH. J Nurs Manag. September 19, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12473742/

4. Crawshaw, J.; McCleary, N. Healthcare Provider Interventions to Support Medication Adherence: State-of-the-Science Overview. Front Pharmacol. July 22, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12322503/