Solutions for Third Party Administrators (TPAs)

Market-Leading Pharmacy Benefits

You are experienced at managing numerous pharmacy options for multiple employers. But what if you could allow your clients to have the freedom to choose without all the administrative hassles? Our focused TPA solution allows employers to choose the best pharmacy plan from multiple options with a streamlined implementation process and consistent approach. RxBenefits elite offering provides deeper savings, exceptional clinical oversight, and a superior service experience. Enjoy peace of mind being able to offer market-leading pharmacy benefits without any heavy lifting!

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Contract Management

Your path to better value begins with a pharmacy contract that works for you.

Tap into RxBenefits’ market-leading purchasing power to place better pricing and rebates in the palm of your client’s hand. With no cost or obligation, deliver a customized savings estimate with multiple plan options that outlines potential member impact, making it easy for your client to select the best plan to achieve their goals.

Best Rates & Rebates

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

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 client’s bottom-line.

Transparent Terms

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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 clients with client-centric terms, clear definitions, and no hidden conditions. You’ll have full visibility into how your client’s contract is performing so there are no unfortunate surprises later.

Ongoing Stewardship

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

In addition to securing substantial first-year savings, put RxBenefits to work as an ongoing steward of your client’s pharmacy contract. We’ll conduct annual reconciliations to ensure your clients’ contracts have met all guarantees and they receive all that is promised. Plus, we’ll deliver annual pricing refreshes and 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.

GET MY ESTIMATE
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Utilization Management

Deploy a tailored clinical strategy to take your pharmacy plan performance to the next level.

Put RxBenefits’ full-time team of licensed, independent pharmacists to work for you, your clients, and members—not the PBM or drug manufacturer. Help your clients realize incremental savings, improve member safety, and optimize population health with advanced utilization management solutions. Our clinical team will design a strategic set of utilization management programs that help eliminate waste, better manage specialty costs and drug trend, support patients with chronic conditions, and increase member health and safety.

Essential Utilization Management

Take the first steps towards being certain your clients have the optimum, most cost-effective clinical approach.

A basic goal for each client’s pharmacy benefits plan is to ensure employees and members have access to the appropriate medication for their condition(s). RxBenefits’ essential utilization management solutions lay the groundwork for a safe and effective pharmacy program using tried and true methods.

Step Therapy

Guarantee the appropriate lowest-cost equivalent drug is tried prior to higher cost alternatives.

Quantity Limits

Enforce reasonable quantity restrictions for certain medications, such as high-cost specialty and opiates.

Basic Prior Authorization

Require rules-based, electronic pre-approval for certain medications to help reduce inappropriate prescribing.

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.

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Experience Management

Increase value for your clients by leveraging our pharmacy benefit experts to deliver exceptional service.

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.

Exceed everyone’s expectations with a high-touch service experience.

Trust a partner that sees you as a top priority and treats your members like family.

Rapid Implementations

Allow clients to choose the best pharmacy plan from multiple options while still enjoying a speedy implementation and the seamless coordination of medical and pharmacy accumulators.

Expert Consultation

Rely on our TPA focused pharmacy experts to understand your needs, clients’ goals, and provide a long-term strategy that optimizes each client’s pharmacy and leverages data-driven insights to achieve each client’s goals.

Exceptional Service

Hire the partner that goes above and beyond to make every client, employee and member feel deeply valued and appreciated, with every interaction.

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