Lowest Net Cost Structure
Every fill is routed to the lowest available net cost option, including generics, biosimilars, and better sourcing channels when clinically appropriate.
Pharmacy Transparency
See what your pharmacy plan actually costs.
Most employer plans overpay for pharmacy through hidden spread pricing, retained rebates, and avoidable brand dispensing. Level Health removes unnecessary markup while making sure members get access to the drugs they need.
89.4%Generic Dispense Rate
$91Current PMPM Pharmacy Spend
100%Rebates Passed Through
$0Spread Pricing Markup
$343,360 Annual SavingsIdentified on 4 medications across 24 members
Real-World Case Study
$343,360 annual savings. Four medications. One group.
A Level Health pharmacy review found significant overspend on specialty and GLP-1 medications. Routing members to lower-cost, clinically appropriate options produced meaningful recurring savings and reduced PMPM pharmacy spend from $191 to $91.
| Medication | Annual Spend | Cost Comparison | Annual Savings | Members |
|---|---|---|---|---|
| HumiraImmunosuppressant / Biologic | $130,000 | $8,000/mo$675/mo | $119,000 | 3 |
| StelaraImmunosuppressant / Biologic | $168,000 | $28,000/mo$10,000/yr | $158,000 | 1 |
| OzempicGLP-1 / Diabetes | $54,700 | $958/mo$300/mo | $27,506 | 11 |
| MounjaroGLP-1 / Diabetes | $54,600 | $1,046/mo$359/mo | $28,854 | 9 |
Total annual savings identified
$343,360/year
How This Works
Four principles. Zero hidden margin.
Zero Spread Pricing
The plan pays the true pharmacy cost plus a clear admin fee. There is no invisible claim markup retained by a middle layer.
100% Rebate Pass-Through
Manufacturer rebates return to the plan in full. No retained share hidden in fee structures or reclassified line items.
Clinical Medical Necessity
High-cost medications are clinically reviewed for necessity and alternatives so members receive appropriate therapy while plans avoid preventable waste.
Spread Pricing Explained
Where the dollars go in each model
Traditional PBM Model
Pharmacy dispenses drugActual cost example: $150
PBM bills plan at a higher amountMarkup example: plan charged $400
Hidden spread retainedDifference kept as margin
Outcome: employer sees a "negotiated" claim but still overpays.
Level Health Model
Pharmacy dispenses drugActual cost example: $150
Plan pays actual cost + admin feeNo spread retained
Full claim visibilityEvery dollar is auditable
Outcome: $0 spread and clear pharmacy economics.
Rebate Transparency
Every rebate dollar goes back to the plan.
Traditional PBM models commonly retain a meaningful share of manufacturer rebates. Level Health passes through 100%.
Clinical Stewardship
Every high-cost script gets active review.
01
Prescription submittedMember/provider submits through normal workflow.
02
Clinical alternatives assessedGeneric, biosimilar, and sourcing options reviewed.
03
Medical necessity validatedDosing and indication checked by clinical team.
04
Lowest net cost identifiedMost cost-effective clinically appropriate channel selected.
05
Transparent dispenseMember receives medication without spread pricing markup.
89.4%
Generic Dispense Rate
$91Current PMPM Spend
$1MTotal Plan Spend
10.6%Brand Rate
Cost Structure
Generics first. Brands only when needed.
Level Health maintains a high generic dispense rate through active clinical guidance. Brands are used when medically necessary, not because rebate dynamics distort formulary behavior.