Give Your Clients and Their Members the Benefit of Layered Solutions

RxBenefits partners with benefits advisors to provide a comprehensive offering of multifaceted solutions to help self-funded employers save significant dollars on pharmacy benefits, lower their risk of catastrophic specialty claims, enhance the health and safety of members, and experience world-class service.

Comprehensive layered approach
Protection Level: 1 Optimize 360

Big-Company Leverage in the Hands of Plan Sponsors

Every client deserves contract terms aligned with their interests and client and member service aligned with their needs. Our flagship solution, chosen by 80% of our clients, puts our aggregate Fortune 100-level purchasing power and our award-winning service to use in their favor. Optimize 360 handles every aspect of the pharmacy benefits process, from initial contract negotiations to ongoing plan support and exceptional client and member service. It starts by securing 12-month contracts with the Top 3 PBMs, including market-leading pricing and transparent, client-aligned terms. Based on 2023 client experience, clients see average first-year savings of 28% or more, with an additional 10% or more year over year. Optimize 360 offers the perfect combination of savings, exceptional service, and proven, consistent results.

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Protection Level: 2 Protect

Independent Clinical Oversight and Intervention for Better Outcomes

To ensure a healthy bottom line and the health and safety of their employees, an employer needs a pharmacy benefits partner focused solely on doing what’s in the best interest of the plan and its employees. RxBenefits’ independent team of licensed PharmDs operates free from any PBM or carrier influence to ensure members always get the safest, most clinically appropriate, most cost-effective medication for their condition. Leveraging chart notes, medical records, and well-established clinical best practices and guidelines, they make independent prior authorization decisions that ensure the best care at the lowest possible cost. This team provides broad oversight of the plan, with a focus on the plan’s most vulnerable members with the most expensive medications and complex conditions.

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Protection Level: 3 Bridge

Preferred Financial Assistance to Lower Costs and Improve Access

When the impact of rising drug costs hits the pharmacy benefits budget of self-funded employers, financial assistance can be critical to their financial health. RxBenefits preferred Patient Financial Assistance solutions help companies provide needed specialty medications to their employees while remaining fiscally responsible. Combined with Protect, our proprietary suite of clinical oversight programs, Patient Assistance solutions help employers save money with the help of manufacturer assistance, carefully vetted patient assistance partners, and discount programs to provide members access to appropriately prescribed, high-cost specialty medications.

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RxBenefits Sister Company
Protection Level: 5

Solutions for Surviving Catastrophic Specialty Claims

The growing challenge of large and catastrophic specialty pharmacy claims can create a risk of financial disaster for self-funded clients. RxPharmacy Assurance, offered through our sister company and sold through licensed advisors, is pharmacy-only stop-loss insurance to provide added protection above and beyond traditional stop-loss coverage. This solution offers an array of attachment points, so employers can choose the deductible that works best for them, and covers virtually all specialty conditions and medications. With RxPharmacy Assurance, employers never have to worry about the danger of a very high-cost specialty drug claim threatening their financial health.


Other Solutions

Hospital Solutions

Tailored Solutions Aligned with the Needs and Resources of Hospitals and Health Systems

From economic impact to government regulation to employees who double as patients, healthcare clients have unique needs and requirements regarding pharmacy benefits. RxBenefits leverages our expertise to partner with hospitals and health systems to create tailored solutions that meet their needs, including maximizing the client’s 340B program and making the most of its in-house pharmacy. Decades of healthcare-specific experience allows us to design client-aligned plans that avoid common (and not-so-common) contractual pitfalls, aided by our hospital-focused account management and award-winning member service teams who deliver peace of mind for clients and their members.

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Optimize MyCare

Protecting Employers and Members from the Cost of Poorly Managed Diabetes

For most plan sponsors, medications for diabetes and metabolic syndrome (also known as pre-diabetes) are a top expenditure. For employees, the health impact of poorly managed diabetes can be devastating. The Optimize MyCare Diabetes Support Program, provided through RxBenefits’ partnership with Tria Health, offers pharmacist-led, human-to-human support, care coordination, and education to help members with these conditions become and remain healthy.

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