Healthcare-and-Pharmacy-Navigation-Enhancing-Healthcare-Consumerism

Healthcare and Pharmacy Navigation – Enhancing Healthcare Consumerism

07/22/2025 Written by: Keenan Pharmacy Services

As healthcare systems grow more complex, as does the complexity for consumers trying to manage and understand their benefits. Yet many of the systems designed to support them often lack clarity and accessibility, especially in pharmacy. As medication costs rise and treatment options expand, effective healthcare and pharmacy navigation is essential to helping individuals make informed, cost-conscious decisions.

Pharmacy Benefit Administrators (PBAs) are uniquely positioned to lead this effort. By prioritizing transparency, simplicity, and proactive support, PBAs play a critical role in advancing healthcare consumerism and improving outcomes.

PBAs are professionals responsible for managing how pharmacy benefits are delivered and can serve as a bridge between health plans, pharmacy benefit managers (PBMs), employers, and members. They ensure benefits structures are communicated clearly, member programs are compliant with regulations, processes are simplified and easy to follow and ensure individuals can access critical medications efficiently and affordably. By improving clarity and enabling informed choices, PBAs are helping shape a more consumer-focused approach to healthcare.

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Make Formularies Understandable

Formulary changes can introduce confusion—especially when coverage shifts rapidly. A 2025 CMS Office of Inspector General report revealed that Humira biosimilar coverage by Medicare Part D plans jumped from 65% in 2024 to 96% in 2025 (OIG). This volatility makes understanding cost tiers, copay structures, and preferred drug options more difficult for members.

PBAs can address this by ensuring formularies are accessible, visually organized, and written in plain language. Highlighting coverage tiers, copay differences, and generic alternatives allows members to make smarter choices. Embedding this information in mobile tools or portals ensures that it’s available when members need it most—at the point of decision-making.

Use Digital Tools That Empower

Amid rising healthcare costs, organizations in 2025 are placing greater emphasis on digital navigation tools to help consumers engage more effectively. Cigna highlights this trend in its top healthcare predictions for 2025, citing increased reliance on virtual guidance and transparency platforms to help members make informed care decisions (Cigna Newsroom).

PBAs can go further by integrating real-time benefit checks at the point of prescribing, directing members to preferred sites of care, or notifying them about available copay assistance. These tools reduce surprise costs and improve adherence by making the pharmacy experience more predictable.

Provide Clinical Support for High-Cost Medications

According to the IQVIA Institute’s 2025 U.S. Medicine Trends report, obesity and diabetes therapies—especially GLP-1 agonists—are now key contributors to overall prescription spending growth (IQVIA, 2025). As these drugs become more widespread, ensuring access and support becomes a strategic priority.

Pharmacist-led outreach and clinical coordination can make a significant difference. Members benefit when they’re guided through the prior authorization process, educated on expected side effects, and provided long-term adherence support. These programs not only reduce early discontinuation but also improve therapeutic outcomes.

Leverage Data to Intervene Early

According to a 2025 Drug Topics interview from the Asembia AXS25 conference, pharmacy organizations are accelerating their use of automation and real-time analytics to reduce delays and improve patient support (Drug Topics). This data-driven approach enables early interventions and personalized outreach to high-risk members.

Healthcare and pharmacy navigation is more than a support function, it’s a core strategy for driving better health outcomes and enabling smarter consumer choices. PBAs who invest in clear communications plans, real-time digital tools, targeted clinical support, and data-informed interventions are not only enhancing healthcare consumerism, they’re redefining what pharmacy benefit management means in a modern system.

Connect with your AssuredPartners team today to learn about the options that may be available to your organization today.

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