The pharmacy benefits landscape is changing quickly, prompting health systems to adapt. With rising drug costs, regulations, and increasing demands for transparency, many are rethinking their reliance on legacy PBM contracts and are exploring modular, tech-enabled models that provide greater control, visibility, and alignment with patient care.
Why Technology-Driven Solutions Are Redefining Pharmacy Benefit Management
For decades, traditional PBMs promised simplicity through consolidation, with one vendor managing everything from claims processing to formulary development and rebate contracting. While once efficient, these bundled models can create rigid structures that limited access to real-time data and reduced the agility needed to manage pharmacy costs and patient outcomes.
Today, modern technology is reshaping that approach. API-enabled platforms and systems allow health systems to unbundle PBM functions, such as claims adjudication, specialty management, clinical programs, or formulary design, and manage them through best-in-class technology partners. Instead of being locked into a single vendor’s system, organizations can integrate specialized solutions that align with their goals for transparency, performance, and strategic fit.
This shift requires a powerful integration layer and an experienced adjudication and connectivity partner capable of orchestrating these technology components seamlessly. The right infrastructure enables secure, efficient data flow across systems, creating a more connected and responsive pharmacy ecosystem.
According to the 2025 PSG Drug Benefit Design Report, nearly one in three organizations are now exploring or implementing modular strategies. The trend is clear: health systems want more control over how their pharmacy benefits are managed, and modularity delivers that flexibility.
The Technology Powering Modular Transformation
Driving this shift is a new generation of technology purpose-built for interoperability, scalability, and speed. Many legacy PBM systems were built for scale but not for agility or data exchange. In contrast, modern platforms like RxSense use API-driven architecture and real-time data to connect pharmacy benefits with electronic health records (EHRs) and clinical workflows.
This unified infrastructure allows seamless communication across vendors and systems, eliminating the data silos, gaps, and delays that can occur in traditional PBM setups.
“Technology is what makes true modularity possible,” said John Zevzavadjian, President of Enterprise Solutions at RxSense. “Health systems can now bring pharmacy benefits into their broader care strategy, using real-time information to make clinical and financial decisions that truly serve patients.”
How Health Systems Can Take Control
For health systems, modular technology and analytic platforms offer advantages that extend well beyond cost savings. By leveraging RxSense’s flexible technology, organizations can:
- Optimize 340B performance to ensure compliance and maximize savings
- Select best-in-class partners for network, formulary, and rebate management based on proven value
- Integrate pharmacy and clinical data to improve utilization management and patient outcomes
- Enhance the member experience with personalized, data-driven benefit designs that align with patient needs and organizational goals
Building on these capabilities, some health systems are adopting a hybrid model to pharmacy benefit management, insourcing select functions such as claims adjudication or specialty pharmacy, while leveraging RxSense’s technology platform and partner network for others. This approach provides greater control, transparency, and efficiency across the pharmacy ecosystem.
RxSense serves as the technology backbone that connects and coordinates each component, ensuring seamless data exchange, real-time insights, and performance transparency. By integrating best-in-class solutions through a single, flexible platform, health systems gain the efficiency of a unified model while retaining the freedom to choose partners that best align with their goals for cost, quality, and member experience.
The Future Is Modular and Already Here
The direction of the industry is clear: flexibility, transparency, and integration are redefining modern pharmacy benefit management. Modular technology empowers health systems to design benefits that reflect their goals and patient needs–not vendor limitations.
As technology continues to evolve, modular models stand out as one of the most effective paths forward for health systems striving to balance financial sustainability, clinical alignment, and patient-centered care.
To learn more about how RxSense supports health systems with modular technology solutions, visit www.rxsense.com.
