Solutions for Self-Funded Employers

Pharmacy Benefits

You’re a visionary that knows your employees deserve a competitive pharmacy benefit. You’re also a problem-solver that recognizes the need to curb rising costs and derive greater value from your organization’s pharmacy benefits spend. Don’t compromise. Talk to your trusted benefit consultant to learn how our balanced approach to pharmacy benefits will empower you to achieve what otherwise feels like competing objectives.

Contract Management

Market-leading purchasing power begins the journey to a better pharmacy contract.

Harness RxBenefits’ size and scale to secure a pharmacy benefits contract that rivals those extended to Fortune 100 employers, with terms you like and benefits your members will love.

Best Rates & Rebates


Take advantage of competitive, volume-based discounts based on our size, not yours

No doubt about it, pharmacy is a scale business, which means PBMs typically reserve the best rates and rebates for robust employer sized companies. Partnering with RxBenefits, you’ll tap into our market-leading purchasing power to access competitive volume discounts and rebates. We don’t take spread or retain any portion of your rebates, so 100% of your savings are applied directly to your bottom-line.

Transparent Terms


Enter a contract you can understand and measure to be sure it performs as expected

In pharmacy, the terms of a contract can, and often do, significantly alter the price and impact projected savings. We deliver contracts that make sense to you and your consultant with client-centric terms, clear definitions, and no hidden conditions. You’ll have full visibility into how your contract is performing so there are no unfortunate surprises later.

Ongoing Stewardship


Capitalize on favorable market conditions and year-over-year pricing improvements

In addition to securing substantial first-year savings, put RxBenefits to work as an ongoing steward of your pharmacy contract. We’ll conduct annual reconciliations to ensure your contract has met all guarantees and you receive all that is promised. Plus, we’ll deliver annual pricing refreshes so you can take advantage of all the improvements that result from our ever-increasing purchasing power.

Assess Your Savings Potential

Answer a few simple questions to see what an RxBenefits managed pharmacy contract could do for you.

Utilization Management

Intelligent, targeted interventions take pharmacy plan performance to the next level.

RxBenefits’ Clinical Advantage Program, managed by our full-time team of licensed pharmacists, helps properly evaluate the medical necessity, appropriateness, and efficiency of prescription medications. Through tailored approaches that can be implemented and modified based on your savings goals and tolerance for member disruption, you can rest assured that you and your members are paying for the ideal medication to get the optimal health outcome, and nothing more.

Essential Utilization Management

Take the first steps towards being certain your members receive the optimum, most cost-effective medication therapy.

Advanced Utilization Management

Apply greater clinical expertise with managed programs proven to strike the right balance between access and cost.

Manufacturer Incentive Management

Offset the many financial leavers pulled by manufacturers that influence prescribing behavior and medication coverage.

Advanced Utilization Management

Apply greater clinical expertise with managed programs proven to strike the right balance between access and cost. It is possible to achieve greater cost savings with minimal member impact. Trust our team of registered pharmacists to evaluate the medical necessity, appropriateness, and effectiveness of prescription medications through the lens of what is in the medical best interest of the member and the financial best interest of the plan.

Low Clinical Value Formulary

Encourage safe, effective, and less expensive drug alternatives by restricting coverage for non-essential Low Clinical Value medications.

High Dollar Claim Reviews

Mitigate costs associated with off-label prescribing with a personalized clinical review of all high-dollar claims.

In-house Prior Authorizations

Apply a very personalized touch to the review process by having an independent pharmacist review suspect prescriptions and collaborate with care providers, as needed.

Plan Design Management

Deliver better outcomes while optimizing trend management.

Combat the many financial levers pulled by manufacturers to influence prescribing behavior and medication coverage. Preserve member advantages associated with manufacturers’ offers while protecting plan integrity and maximizing the savings potential.

Accumulator Protection

Protect plan integrity while allowing members to use manufacturer-provided coupons to reduce their out-of-pocket expenses at the pharmacy.

Variable Copay

Maximize plan savings by dynamically adjusting copays at the point of sale to take full advantage of all available manufacturer assistance dollars.

Experience Management

An exceptional experience completes your journey to a fully optimized benefit.

When only the best will do, you can count on RxBenefits’ exceptional service model to deliver. Our high-touch approach to client and member service sets us apart in the industry as the only pharmacy partner that answers 100% of calls personally and stays on the line as long as it takes to resolve your concern. We provide expert advice, consultative guidance, and clear direction in every interaction.

A Predictable & Repeatable Implementation Experience

Leveraging a Lean Six Sigma Process, we own the implementation and lead the day-to-day process, working as a natural extension of your team to deliver an exceptional pharmacy benefit program.

A Consultative Account Management Approach

As an extension of your benefits team, we provide strategic insights and recommendations. Leveraging your data as a guiding light, we measure your plan’s performance, optimize results, and align to your goals.

Client & Member Services

Your goals are at the center of everything we do. By leveraging your data, we will gauge your plan’s performance and enhance results. We are focused on going above and beyond by providing strategic insights and suggestions to make every client and member feel genuinely valued and appreciated, with every interaction.

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