Pharmacy Benefits Results

Our clients save a minimum of 15% on their Rx costs in the first year. And on average, 33%.

Check out our client successes

Innovative Rx Difference

What could you do with 7-figure savings?

Are you getting the best pricing from your PBM? The truth is — most employers don’t know. While you shouldn’t have to understand the complexities of the PBM industry, you also shouldn’t pay your PBM more than you have to.

No one can save you more on your pharmacy benefits than a pharmacist.

That is why Apex partners with Innovative Rx Strategies to provide custom solutions to our clients. Innovative is a national firm led by pharmacists — and that makes a difference. They employ six clinical pharmacists, several former pharmaceutical and PBM industry executives and a health care attorney.

If you want to do more for your organization and employees, we can help you save money — funds you can reinvest elsewhere — by getting greater performance and accountability from your PBM.

Pharmacy Benefits Consulting

Innovative Solutions.
Maximum Value.

Our Services

No other independent consulting firm offers the same level of proficiency across the pharmacy, PBM and health care industries as Apex partnered with Innovative Rx Strategies. Our mutual promise is to hold PBMs accountable and do the heavy lifting so our clients realize the best pricing possible from PBMs. And we make sure that discounts, rebates and other manufacturer-derived revenues pass through to you and your members, instead of to the PBMs’ profit margins.

Pharmacy Benefit Savings Assessment

With pharmacy costs accounting for nearly half of total employer health care spend, it’s more important than ever to proactively manage pharmacy costs by taking greater control of PBM contract terms. Our assessments are the most effective way to determine if a current PBM contract has shortcomings or if a PBM is failing to meet its responsibility to provide the highest quality pharmacy benefits at the lowest cost.

The no-risk, no-obligation review includes:

  • Review of your current PBM contract and your most recent 12-months of claims data
  • A promise of no disruption to your current PBM relationship or plan members
  • Transparent and unbiased findings — if we can’t help you save, we don’t get paid
Contact us if you want to see how much you can save

Pharmacy Benefits Plan Design

We take a consultative approach to customizing pharmacy benefit plans that strike a balance between cost containment, patient utilization and accessibility, and optimal patient health outcomes. Our pharmacists identify the most appropriate plan design options, clinical programs, and specialty drug alternatives to help you meet your business goals.

Services and benefits include:

  • Customization of formulary to drive to lowest net cost utilization
  • Management of specialty drugs to minimize impact of high-cost claims
  • Maximization of generics and optimization of rebates to save you and you plan members more
  • Updates on future impact of pharmacy trends and pharmacy benefit legislation

PBM RFP and Vendor Management

Our team leads the day-to-day account management of the vendor relationship and holds the PBM accountable for operational excellence. Our vendor-agnostic approach allows us to deliver pharmacy benefits solutions that match clients with the services they need — at the best pricing possible.

Services and benefits include:

  • Managing the PBM RFP process and negotiating the final agreement
  • Navigating the ins-and-outs of pricing and contract complexities while protecting client interests at every turn
  • Vetting and sourcing PBMs when change is necessary
  • Conducting annual reconciliations and monitoring client-specific performance guarantees

Pharmacy Claims Surveillance

Innovative pharmacists continuously monitor benefit program performance and pharmacy claims, leveraging data and their practical expertise, clinical and financial analysts provide actionable insights to make sure clients receive the greatest value possible from their pharmacy benefits investments.

Services and benefits include:

  • Regular reviews of pharmacy claims data and reporting on employee health risks and utilization trends
  • Evaluation of high-cost drug claims on medical plan for possible cost-savings solutions that minimize member disruption and maximize health outcomes
  • Negotiation direct with PBMs and health care providers when necessary to implement solutions

Medical Claims Surveillance

Our team of clinicians and analysts manage risk by continuously reviewing the pharmacy claims that come through your medical plan. They proactively identify opportunities to mitigate financial risk to the organization and improve the health of plan members — with little to no member disruption.

Services and benefits include:

  • Regular reviews of medical claims data and reporting on employee health risks and utilization trends
  • Analysis of short- and long-term risk to the plan as well as opportunities to optimize treatment cost without impacting member care or health outcomes
  • Direct negotiation with health care providers and carriers when necessary to implement cost-savings solutions

Unrivaled Expertise

Realize pharmacist-led, member-focused savings no other broker can match.

Explore Innovative Rx Strategies

Our Team

Client Success Stories

Recent Insights

  • February 19, 2024

    Employer Impact Report: Explore The Landscape

    GLP-1s for weight loss will impact benefit plans for years to come. Explore the GLP-1 landscape in the second session of the Employer Impact Report on Weight Loss Drugs. This pharmacist-led webinar will help employers build a strategy around high-cost …

  • January 25, 2024

    Employer Impact Report: History of GLP-1s

    Drugs for diabetes and weight loss are a part of the cultural conversation today. But how did we get there. Examine the history of GLP-1s.

  • December 12, 2023

    Health Care Cost Trends for 2024

    Health care costs are on the rise. We are breaking down three health care cost trends for 2024 and how employers can mitigate their financial risk.