HITRUST certified
HIPAA compliant
AICPA SOC
100% U.S.-based
PHARMACY MANAGEMENT
Pharmacy Cost Management & Therapy Optimization
A comprehensive suite of clinical solutions designed to help plan sponsors address emerging pharmacy benefit challenges, improve patient outcomes, and reduce total pharmacy spend — without disrupting core benefit design.
>50%
Provider action rate
0.5-3%
Typical pharmacy savings
6
Leakage analytics
3
Targeted clinical modules
Specialty Spend Optimization
Strategic programs designed to manage the rising cost of complex specialty therapeutics through clinically appropriate interchange and site-of-care redirection.
Benefit Design Alignment
Aligning formulary and benefit structures with value-based healthcare outcomes and rebate economics.
Clinical Utilization Review
Evidence-based pharmacy interventions that ensure right-drug, right-patient delivery through targeted prescriber outreach.
Therapy optimization
A program built around proactive clinical oversight
Secondwave's Therapy Optimization is a comprehensive suite of clinical solutions designed to help plan sponsors address emerging pharmacy benefit challenges and improve patient outcomes. This program integrates with our existing risk and quality workflow, in concert with existing formulary strategy. It delivers targeted, value-added management opportunities that go beyond standard utilization controls. Therapy Optimization focuses on proactive outreach to prescribers, informed by detailed claims analysis and clinical evidence.
Plan sponsors can implement all components, a single module, or a customized combination. Final therapy decisions remain solely with the treating clinician.
Reduce pharmacy drug costs
through clinically appropriate interventions
Improve patient health outcomes
through optimized medication use
Enhance prescriber decision-making
with evidence-based recommendations
Identify and address gaps in care
using advanced claims analytics
Support sustainable long-term
pharmacy benefit performance
Provider action rate
>50%
Recommendations reduce member out-of-pocket costs, aligning clinical guidance with patient affordability that drive real adoption at point of care.
HOW IT WORKS
HOW IT WORKS
From data collection to outcome reporting, Therapy Optimization turns pharmacy insights into actionable clinical recommendations.
Data Collection
Claims, eligibility, formulary, and benefit data
Advanced Analytics
Opportunities, risks, and care gaps identified
Clinical Review
Evidence-based recommendations developed
Clinical Outreach
Prescribers engaged at the point of care
Ongoing Monitoring
Adoption and opportunities tracked over time
Outcome Reporting
Savings, impact, and value measured
A Unified Operating Model for Healthcare Performance
Secondwave's Therapy Optimization program integrates with our existing risk and quality workflow — in concert with existing formulary strategy — to deliver targeted, value-added management opportunities that go beyond standard utilization controls. It focuses on proactive outreach to prescribers, informed by detailed claims analysis and clinical evidence.
Therapeutic Alternatives (TA) Module
Secondwave analyzes prescription claims data to identify opportunities for clinically appropriate, lower-cost therapies. Providers receive targeted education and peer-to-peer clinical support to evaluate potential therapy changes. For plans with carveout capability, the program can also address medical specialty drugs and site-of-care optimization.
Adherence Module
Medication non-adherence drives avoidable costs and poor outcomes. Advanced analytics identify members at risk and alert prescribers for timely intervention. Early outreach improves adherence and reduces downstream medical utilization.
Complex Patient Management Module
Patients with multiple chronic conditions often face complex medication regimens and higher therapy risks. Claims analysis identifies at-risk members and flags issues such as drug interactions, dosing concerns, and duplicate therapies. Providers receive actionable alerts with clinical evidence and recommended next steps.
Typical Savings
0.5% – 3.0%
Typical Savings of Total Plan Pharmacy Spend
Actual savings vary based on baseline plan management and existing utilization controls. Final therapy decisions remain solely with the treating clinician