PBM & Specialty Pharmacies

Take Control of Specialty Drug Spend with Clinical Intelligence

Validate prescriptions. Improve outcomes. Manage pharmacy costs with confidence.

Pharmacy costs—especially specialty drugs—are one of the fastest-growing drivers of healthcare spend. Yet most pharmacy oversight still relies on prescription claims alone, without the clinical context needed to understand why a drug was prescribed or whether it’s appropriate.

That gap leads to unnecessary spend, ineffective therapies, and missed opportunities for intervention.

MedShare CI changes that.

By connecting pharmacy activity to real clinical data, MedShare CI gives PBMs and specialty pharmacies the visibility needed to validate prescribing, monitor therapy effectiveness, and manage specialty drug utilization more effectively.

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The Problem with Claims-Only Pharmacy Oversight

Prescription data shows what was dispensed—not whether it was clinically appropriate.

Without clinical context, pharmacy teams face:

  • Limited ability to validate diagnosis-to-drug alignment
  • Incomplete visibility into treatment history and pathways
  • Difficulty identifying off-label or inappropriate prescribing
  • Gaps in step therapy tracking and adherence monitoring
  • Limited insight into patient response to therapy
The result: higher costs and weaker clinical oversight.

A Smarter Approach to Pharmacy Intelligence

Move beyond utilization management to clinical validation

MedShare CI integrates pharmacy activity with underlying clinical data to deliver a more complete view of drug utilization and patient outcomes.

With MedShare CI, you can:

  • Validate prescriptions against real diagnoses
     Ensure therapies align with clinical need
  • Detect off-label or unsupported prescribing
     Identify risk earlier and intervene appropriately
  • Track step therapy and adherence
     Confirm required protocols are followed
  • Identify non-responders to therapy
     Improve outcomes and avoid wasted spend
  • Detect duplicate or overlapping therapies
     Reduce unnecessary utilization
  • Analyze prescribing patterns across providers
     Gain insight into trends and variation

Strengthen Oversight of High-Cost Specialty Therapies

MedShare CI enables PBMs and specialty pharmacies to monitor specialty drug use within the full clinical context of each patient.

This allows you to:

  • Ensure therapies are clinically appropriate
  • Detect gaps or inconsistencies in treatment pathways
  • Identify patients who are not responding to therapy
  • Prevent redundant or duplicative drug utilization
  • Monitor prescribing behavior across provider networks
Instead of relying on rules alone, you can apply true clinical intelligence to pharmacy management.

Act Earlier on Inappropriate or Ineffective Therapy

MedShare CI helps you proactively identify:

  • Prescriptions not supported by clinical diagnoses
  • Off-label or out-of-guideline drug use
  • Patients failing to respond to treatment
  • Missing or incomplete step therapy sequences
  • Duplicate specialty drug utilization
With this insight, you can intervene earlier, improve outcomes, and control costs more effectively.

Real-World Example

A PBM is reviewing utilization of a high-cost biologic medication.

Pharmacy claims show significant prescribing activity—but provide no visibility into whether prescriptions align with diagnoses or treatment protocols.

MedShare CI reveals:

  • Whether each prescription is supported by a valid clinical diagnosis
  • If required step therapies were completed
  • Patients who are not responding to treatment
  • Instances of duplicate biologic therapies
  • Prescribing trends across providers

With this insight, the PBM can:

  • Strengthen clinical oversight
  • Reduce inappropriate utilization
  • Optimize specialty pharmacy spend
The result: better control, better outcomes, and fewer unnecessary costs.
Business Impact
With MedShare Clinical Intelligence, PBMs and specialty pharmacies can:
  • Improve validation of specialty drug prescribing
  • Detect inappropriate or off-label therapy earlier
  • Reduce unnecessary pharmacy spend
  • Improve patient outcomes through better therapy monitoring
  • Strengthen oversight of high-cost biologics and specialty drugs
  • Gain deeper insight into prescribing behavior and trends
  • Improve validation of specialty drug prescribing
  • Detect inappropriate or off-label therapy earlier
  • Reduce unnecessary pharmacy spend
  • Improve patient outcomes through better therapy monitoring
  • Strengthen oversight of high-cost biologics and specialty drugs
  • Gain deeper insight into prescribing behavior and trends
Bring Clinical Intelligence to Pharmacy Management

Stop relying on prescription data alone to manage your fastest-growing cost category.

MedShare CI gives PBMs and specialty pharmacies the clinical intelligence needed to validate, monitor, and optimize specialty drug utilization with confidence.

Schedule a Demo