Why Smart Employers Are Pairing AI with Clinical Expertise

Pharmacy today is harder than it should be. Costs keep rising faster than inflation, leaving nearly 30% of adults skipping or rationing their prescriptions because of price¹. Formularies stretch on for thousands of drugs with little guidance on what matters for a specific member. At the same time, almost 70% of Americans take at least one prescription daily, and more than one in four manage four or more². The complexity is staggering — and the consequences of getting it wrong are serious.

In response, innovative healthcare organizations are turning to AI-driven digital tools that simplify access to care, ease the strain on providers, and equip employers with sharper insights to guide benefit strategy.

Nowhere is this shift more evident than in the pharmacy benefits industry, where decisions hinge on timing and accuracy — and where AI, especially Predictive AI, is already making a clear difference. It goes far beyond improving the conversation with members: Predictive AI can process millions of data points in real time, tailor the right benefits with the right members, predict which members are at risk of running into problems, and surface the best lower-cost, clinically equivalent options in seconds. That kind of foresight is something no human alone could deliver at scale. It’s an important breakthrough in a part of healthcare that has been reactive and fragmented for far too long.

But foresight alone isn’t enough. A 2023 Pew survey found that 60% of Americans would feel uncomfortable if their provider relied on AI to make care decisions³. The hesitation is clear: members not only want answers, but they need assurance. They want to know that their health is in the hands of people they trust.

AI creates foresight. Clinicians create trust. Together, they create action.

That combination is what actually drives results.

AI can flag that a member is likely to stop taking a maintenance drug, but it takes a clinician to explain why adherence matters and adjust therapy if needed. AI can identify a $200 alternative, but members are far more likely to make the switch when a pharmacist confirms it’s clinically appropriate. AI can cut through thousands of drug choices, but only clinicians can give those choices meaning. Technology predicts the what. Humans provide the why.

The cost of not combining the two is high. Poor adherence alone drives up to $300 billion in avoidable healthcare costs each year⁴. Formularies continue to expand, and without both predictive tools and clinical validation, members are left overwhelmed, providers overloaded, and employers carrying the weight of inefficiency.

When AI and clinicians work together, members experience something different.

They see only what’s relevant to them. They know their costs in advance, and they trust the guidance they’re given. They no longer face gaps in care because a pharmacist has already coordinated with their provider, and their next steps have already been made with full clarity. Instead of a confusing, reactive system, members experience a pharmacy journey that’s connected, clear, and actionable.

For organizations that implement AI-powered digital tools backed by clinical experts, the impact extends well beyond better pharmacy experiences. Members who feel supported and understood become healthier, more engaged, and more loyal. In turn, offering modern, tech-enabled benefits demonstrates a commitment to both innovation and care — positioning employers as progressive in their strategy and giving them a decisive edge in retaining and attracting top talent.

The future of pharmacy isn’t AI alone. And it isn’t human alone. It’s both. AI delivers the foresight to anticipate what’s coming. Clinicians provide the trust to act on it. And when human expertise and technology blend together, pharmacy shifts from one of the most confusing parts of healthcare into one of the most supportive where everyone benefits.

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