Heavy direct-to-consumer advertising of high-cost medications is fueling patient demand and placing added pressure on physicians to prescribe the drugs that patients recognize — even when lower-cost alternatives may be just as, or more, effective. The scale of this influence is significant: In 2025 alone, Novo Nordisk spent approximately $54 million per month promoting Ozempic across TV and digital channels.
Major PBMs have responded to this demand by approving over 90% of these medications. While this may please patients, it doesn’t necessarily account for appropriateness of care or cost efficiency for the plan.
MedBen Rx takes a different path. Every medication claim is reviewed against evidence-based clinical guidelines to determine whether it is truly the best option for the patient — not simply the best known. That means we don’t default to automatic decisions on high-cost medications, but instead evaluate each case on its individual merit.
This clinical approach leads to more effective utilization:
- 39% approval rate for GLP-1s (such as Ozempic and Mounjaro)
- 29% approval rate for high-cost migraine medications (Nurtec, Ubrelvy)
- 55% approval rate for anti-inflammatories (Skyrizi, Tremfya, Rinvoq)
MedBen Rx understands that approving or denying prescription drugs is not meant to be a rubber stamp. Rather, our goal is to ensure your members receive the right medication based on proven outcomes and sound medical evidence, not the size of an advertising budget or a catchy ad jingle.