The problem

The prescription leaves the building.
So does the revenue.

Health systems bear every cost of generating a prescription. Most of the resulting revenue goes somewhere else.

Four structural failures
01
Health systems bear every cost
The physician salary. The clinical infrastructure. The liability. The relationship. Every prescription is written at the health system's expense — with no guarantee the resulting revenue returns to it.
02
Retail chains capture every dollar
By default — no prompt, no comparison, no alternative — the prescription routes to a retail pharmacy chain. The dispensing margin, the 340B spread, and the patient relationship leave the health system that generated them.
03
The default is structural
This is not a process problem. It is an infrastructure problem. The system default routes prescriptions away from the health system before any human decision is made. No physician chooses this. It simply happens.
04
RxClad changes the default
At the prescribing moment. Automatically. Inside the clinical workflow. Zero disruption for physicians. The revenue that was leaving now stays.
See how RxClad fixes it →
The scale
$494.9B
Annual US prescription spending · CMS 2025
88%
Fills at retail chains by default — no prompt, no comparison, no alternative
$436B
In prescription revenue routing away from the health systems that generated it

Health systems write every prescription. They capture almost none of the economics. This is not a rounding error. It is the largest structural misalignment in US healthcare.

The architecture of the problem

Prescription revenue follows a path.
Most of it never returns to the health system.

Health system
Employs the physician. Funds the infrastructure. Bears the liability.
→
prescription
PBM
Routes the claim. Sets the mandate. Captures the spread.
→
routing
Retail pharmacy
Dispenses the drug. Captures the margin. Owns the patient relationship.
→
revenue
Health system
Captures nothing from the transaction it created.
Every health system in America is leaving significant pharmacy revenue on the table.
Every single one.
The systems and infrastructure were designed for everyone else — except the health systems.

RxClad, Inc. · hello@rxclad.com · 2026