Comprehensive Solution
From the start, RxBenefits is different. We’re fully aligned with our clients and their goals, and have the operating model to prove it:
- Plan design insights based on the plan’s own demographics and data
- A curated marketplace of traditional and transparent pharmacy benefits management (PBM) options
- Comprehensive, human-led clinical management to eliminate wasteful spending. And we guarantee our results.
- Zero financial conflicts. We do not benefit from formulary incentives, rebates, or spread pricing.
- Flexible solutions proven to deliver strategic savings
- A 30-year track record of delivering award-winning service to more than 3 million members
- Scalable solutions backed by our experience and expertise managing more than $3B in spend
A Marketplace of Options
Our one-of-a-kind marketplace fosters competition among best-in-class traditional PBMs and the new transparent PBM option, Illuminate Rx, along with other specialty cost containment programs, enabling clients to choose a benefits solution aligned to their unique plan goals and member needs.
The marketplace includes the three largest traditional PBMs. RxBenefits acts as an objective third party to help clients decide if a traditional PBM is right for them, and which option best suits their individual needs.
Illuminate Rx, a transparent pharmacy benefits solution, is the newest addition to the RxBenefits marketplace, with a member-first philosophy and a focus on driving to the lowest possible net cost. Unlike traditional PBMs, Illuminate Rx provides unprecedented clarity by offering 100% visibility into all drug costs, utilization data, and rebates. It offers flexible plan design, formulary, and network strategies tailored to client goals – improving outcomes and prioritizing generics and biosimilars to drive down total cost of care.
Independent Clinical Management That Prioritizes Members and Lower Costs
RxBenefits’ human-led clinical utilization management helps clients balance plan cost control and member access goals by targeting high-cost, high-risk claims and ensuring the right member gets the right drug at the right cost. We apply a higher standard of care with an independent team of clinicians thoroughly reviewing chart notes, lab results, and medical records to make unbiased, evidence-based prior authorization (PA) decisions aligned with U.S. Food and Drug Administration (FDA) guidelines. This outcomes-focused approach eliminates waste and drives better health outcomes.
Additional Cost Containment Options
With specialty drug prices continuing to soar, and a robust pipeline of them, RxBenefits delivers targeted cost containment strategies to make these expensive therapies more affordable – without compromising access or quality of care.
Our approach combines clinical expertise with alternative funding strategies to support plan savings and member health:
- Manufacturer copay assistance programs that reduce member out-of-pocket costs
- Patient assistance programs for eligible members
- International sourcing options for select high-cost medications
- Diabetes and weight management, in partnership with Tria Health, to control costs associated with one of the biggest drivers of pharmacy spending.
This comprehensive model helps clients manage specialty pharmacy spend while ensuring members receive the medications they need.
Tailored Solutions Aligned with the Needs and Resources of Hospitals and Health Systems
From strained financials to government regulation to employees who double as patients, healthcare clients have unique needs and requirements of their pharmacy benefits. RxBenefits leverages our expertise to partner with hospitals and health systems to create tailored solutions that meet these needs, including maximizing the client’s 340B program and making the most of in-house pharmacies. Decades of healthcare-specific experience allow 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.
Diabetes Support Program
Protecting Clients and Members from the Cost of Poorly Managed Diabetes
For most clients, 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. In partnership with tria HEALTH®, RxBenefits offers pharmacist-led, human-to-human support, care coordination, and education to help members with these conditions become and remain healthy.
Account Management
Responsive, effective account management like you’ve never experienced.
Our Account Management teams function as extensions of our clients, finding quick, effective solutions to their biggest pharmacy benefits problems so they can focus on their business. Dedicated teams are based throughout the U.S. to be closer to the clients they serve, providing regular, ongoing reporting and proactive recommendations if adjustments are needed. We give our clients what we’d want for ourselves: care, compassion, and a focus on quick resolution.
48
NPS*
Offering world-class service and support.
We’re particularly proud of our client Net Promoter Score (NPS) of 48*. NPS is a measure of customer loyalty, and in an industry where most companies have a score below ten, we’re pleased our clients find our service to be world-class.
*Among clients highly familiar with RxBenefits
Client Services
When you need support now, you need it now.
Our Client Services and Account teams work together to ensure clients get the help they need exactly when they need it. Client Services is a centralized, accessible, responsive team technologically equipped to handle issues like eligibility questions or drug overrides. Employers and benefits advisors also have access to their plans via two distinct self-service portals: My RxBenefits Book for benefits advisors and My RxBenefits Plan for employers.
Member Services
Because members don’t reach out for help with things that don’t matter.
Whether they’re trying to get medication for a loved one or they just have a question and need a quick answer, members’ concerns deserve immediate attention. Every call to our 100% U.S.-based Member Services team is quickly directed to a live, compassionate representative who is equipped and empowered to help. Our team members are evaluated based on how well they help members who call with problems, not how quickly they can get those members off the phone – which is reflected in our four consecutive Stevie Awards for excellence in customer service.
Additionally, our member portal, gives members easy access to their benefits and communication with our team from the tip of their fingers.
Contact Member Services
Monday – Friday
7:00 am – 8:00 pm CST
800.334.8134
customercare@rxbenefits.com
