fbpx Services 360 - Pharmacy Benefits | RxBenefits


Advocacy, expertise, and service for better pharmacy solutions.

The all-encompassing solution for pharmacy benefit management.

We'll manage every aspect of your client's pharmacy plans. Benefits include volume-purchasing discounts, a boutique service model with access to Member and Client Services (Customer Service), our in-house assistance center for members.


Insightful consulting at your service.

Let us consult on your pharmacy accounts. From PBM procurement to ongoing guidance, you’ll gain insights and strategies from industry-leading experts to keep you ahead of the benefit curve.


A flexible solution, tailored to each hospital’s unique needs.

RxBenefits’ Hospital Program provides best-in-class, consultative service tailored to each hospital’s unique needs, resulting in an aligned, hospital-centric relationship not found in the market today. The RxBenefits core model is uniquely positioned to support the distinct needs of the hospital market.



The management you need with the service you want.

Our all-encompassing solution to pharmacy plan management and administration.

For a complex medical issue, you’d call in a specialist. Our advice: Treat complex pharmacy plans the same way and call us. We’re pharmacy benefit specialists, offering complete, end-to-end solutions for pharmacy plan management. Point by point, we’ll implement a plan that outperforms previous contracts and exceeds every service expectation.The result: Happier employees and a healthier ROI for your client’s pharmacy plan.

Clinical Advantage Program

Our Clinical Advantage Program provides clients with sustainable pharmacy strategies, tailored to help each client meet their specific goals and needs. Our independent approach allows us to leverage our expertise, while working with our PBM partners and our clients, to deliver a comprehensive clinical solution with greater visibility and maximum value. RxAnalyzer™, our proprietary data analytics platform, allows us to gather a detailed view into each client’s drug utilization and spend patterns.

We employ a specialized team of in-house pharmacists to guide our clinical processes. The clinical program we design for each client contains a precise, targeted mix of our Clinical Advantage Program strategies:

  • Formulary Optimization: Developing a formulary strategy that generates the most value for our clients, through rebates and appropriate exclusions
  • Foundational Utilization Management: Ensuring the lowest-cost equivalent drug is used first; managing appropriate drug quantities and indications
  • High Dollar Claim Review: Providing umbrella protection to guard against high-cost claims typically associated with inappropriate medication use, misuse, errors or fraud
  • Manufacturer Assistance Program for Specialty Medications: Leveraging additional manufacturer savings to benefit both the member and the plan
  • Population Management – Diabetic Monitoring: Encouraging integrated monitoring and coordinated patient care for a major healthcare issue facing our clients

We evaluate client claims data to identify trend drivers and clinical inefficiencies. We then apply our independent clinical expertise to model client-specific savings and potential member impact, and report our assessment. Our recommended strategy is reviewed with clients to let them decide how to effectively manage their plan – ensuring a client-aligned pharmacy management approach.  


Independent Assessment of Current Pharmacy Arrangement:

New client relationships begin with an objective assessment of the existing pharmacy contract. Our methodology measures the contract’s performance against the market, reveals the plan’s actual adherence to contract terms and pricing and identifies weaknesses. Using these results, we develop a more beneficial course of action, as well as discover untapped opportunities to pursue in new plan designs and utilization management programs.


Real Savings

Our clients save an average of 10% on the initial re-price and analysis. Once the contract is in place, we monitor the market to ensure pricing terms remain competitive. Our contracts comprise a one year term, ensuring flexibility to renegotiate annually to reflect current market trends.


Discounted Volume Pricing

Small to mid-sized employers lack the negotiating clout to secure the best rates with PBMs, TPAs, and healthplans. Often, they can’t even get a contract that guarantees rates. RxBenefits leverages the aggregate membership of our entire client portfolio to secure volume discounts, ensuring competitive and auditable contracts negotiated to your client’s advantage.


Competitive Terms

Rather than standard pharmacy contracts that offer fixed terms for multiple years, RxBenefits contracts are renegotiated annually to ensure they are competitive and reflect current trends. Among the criteria we consider:

  • Brand, generic, and specialty definitions
  • Ingredient cost discounts by channel (90-day retail, mail, and specialty)
  • Dispensing fees
  • Administrative fees
  • Rebates
  • Formulary and drug coverage options
  • Pharmacy network options
  • Clinical program options


Direct PBM contract with RxBenefits

We provide a direct contract with pre-negotiated terms and conditions favorable to the client, fully transparent and auditable. By utilizing an addendum to the master PBM contract, we keep the process simple and convenient.


Claims Auditing and Reconciliation against Financial Guarantees

RxBenefits conducts random claim audits to ensure financial performance adheres to contractual terms. If discrepancies are found, we ensure our clients are “made whole.”


Strategic Analysis and Reporting

We excel in data analysis, delivering monthly, quarterly, and annual performance evaluations. Keeping a close eye on data reveals opportunities for plan design and clinical changes to reap additional savings.


Quarterly Performance Reviews

A pre-determined review schedule allows us to report on plan performance, recommend potential revisions needed at renewal and present modeling of future changes.


Designated Account Service Team

From day one, a designated RxBenefits team services each client account. Trust us to monitor contract details, verify terms and ensure benefits are processed correctly. Our account team knows a client’s business inside and out, providing ongoing support and communication through detailed reviews and periodic meetings. Our team also acts as an extension of a client’s human resources department, able to assist with all activities related to pharmacy benefits.


Member Services Call Center

Customer service is provided by Member and Client Services (Customer Service), an in-house customer service center staffed by RxBenefits associates in our Birmingham, Alabama, headquarters. Rather than the usual automated call system, members get prompt access to “live” knowledgeable customer service representatives. Focused on member satisfaction from start to finish, our team is ready to call a physician, pharmacy or others to resolve issues quickly and efficiently.


Data Integration Resources

We operate a proprietary data system to integrate a client’s claims and eligibility files, ensuring superior accountability, data security, integrity and accessibility independent of the PBM. This technology gives us the ability to quickly analyze data and customize reports, with access to real-time numbers to address questions or concerns. It’s  also user-friendly, enabling HR personnel to easily verify eligibility. Through our clearinghouse service, we can provide a client’s claim
files to third party vendors.


Plan Implementation Support

Implementing a new pharmacy plan can be time intensive for an employer. To ease the workload, RxBenefits manages the entire process. From providing ID cards and plan materials to conducting employee benefit presentations, we ensure a smooth and accurate transition to RxBenefits.