Healthcare cost savings from an adaptive medication management program: A retrospective cohort study

Traditional pharmacy benefit manager (PBM) structures generate revenue through approaches that limit pharmacist-led optimization. Adaptive Medication Management (AMM) decouples pharmacy revenue from prescription throughput through direct-pay contracting, enabling coordinated care across fulfillment sources while maintaining PBM access.

To evaluate the economic impact of a pharmacist-led adaptive medication management (AMM) program on pharmacy, medical and total plan spending for a self-insured employer.

This retrospective cohort study examined the relationship between enrollment in a pharmacist-led AMM program and plan paid pharmacy, medical, and total costs per member per quarter. Members were 1:1 propensity score matched using exact matching on index year. Analysis involved difference-in-differences with two part generalized linear models and calendar year fixed effects. Direct pharmacy savings compared realized acquisition cost with the plan's contracted PBM price for identical prescriptions, standardized for estimated forgone manufacturer rebates.

Among 1,231 engaged members, 541 met analytic eligibility criteria. Propensity score matching produced 172 matched pairs. AMM enrollment was associated with estimated reductions in total plan cost of $419 per member per quarter before program fees (95% CI, -$1,522 to $655) and $223 after fees (95% CI, -$1,326 to $777), and pharmacy cost of $292 (95% CI, -$907 to $109). The estimated difference in medical cost was $4 (95% CI, -$888 to $812). Across 13,248 prescriptions, rebate standardized savings relative to expected PBM cost totaled $2,080,996 (38.0%; $157 per prescription). Between 43% and 66% of enrolled members' pharmacy spending continued to be adjudicated through the PBM.

AMM achieved substantial prescription level savings, but these did not translate into a clearly established reduction in total plan spending. The findings suggest AMM may function as a complementary approach to existing pharmacy benefits, with its economic value depending on how much medication spending is routed through the program and the costs of providing the service.