WHO WE SERVE
This fiduciary business model ensures our
motivation to be a steward of your best interests.
motivation to be a steward of your best interests.
Self-Funded Employers
We are employee pharmacy benefits specialists helping employers with anywhere from 100 to 50,000 members reduce pharmacy costs.
Brokers and Consultants
We make it possible for health insurance brokers and employee benefit consultants to grow revenues while at the same time slash their clients’ pharmacy costs. As Fiduciary PBM, we do it at a fraction of the cost of our competitors.
Health Plans and Systems
Is it more beneficial to outsource or bring the PBM management in-house? For us it doesn’t matter as we help with either scenario. Simply put, our goals are in direct alignment with yours.
WHAT WE OFFER
Your pharmacy benefits, your way.
Fiduciary
Business Model
Traditional
Business Model
Reinvestment
Business Model
Pass-Through
Business Model
Transparent
Business Model
Fiduciary
Business Model
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Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
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Site of care management One of the biggest opportunities to reduce specialty drug costs. |
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Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
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65,000+ retail pharmacy network Major chains and independents included. |
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Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
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835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
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Flexible benefit design Prevent fraud, waste and abuse, for instance. |
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| Custom formulary Drives lowest net cost. |
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24/7 member support Both English and Spanish speaking staff. |
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Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
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Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
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Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
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Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
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|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
Traditional
Business Model
|
Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
|
|
Site of care management One of the biggest opportunities to reduce specialty drug costs. |
|
|
Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
|
|
65,000+ retail pharmacy network Major chains and independents included. |
|
|
Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
|
|
835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
|
|
Flexible benefit design Prevent fraud, waste and abuse, for instance. |
|
| Custom formulary Drives lowest net cost. |
|
|
24/7 member support Both English and Spanish speaking staff. |
|
|
Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
|
|
Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
|
|
Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
|
|
Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
|
|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
Reinvestment
Business Model
|
Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
|
|
Site of care management One of the biggest opportunities to reduce specialty drug costs. |
|
|
Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
|
|
65,000+ retail pharmacy network Major chains and independents included. |
|
|
Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
|
|
835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
|
|
Flexible benefit design Prevent fraud, waste and abuse, for instance. |
|
| Custom formulary Drives lowest net cost. |
|
|
24/7 member support Both English and Spanish speaking staff. |
|
|
Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
|
|
Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
|
|
Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
|
|
Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
|
|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
Pass-Through
Business Model
|
Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
|
|
Site of care management One of the biggest opportunities to reduce specialty drug costs. |
|
|
Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
|
|
65,000+ retail pharmacy network Major chains and independents included. |
|
|
Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
|
|
835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
|
|
Flexible benefit design Prevent fraud, waste and abuse, for instance. |
|
| Custom formulary Drives lowest net cost. |
|
|
24/7 member support Both English and Spanish speaking staff. |
|
|
Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
|
|
Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
|
|
Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
|
|
Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
|
|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
Transparent
Business Model
|
Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
|
|
Site of care management One of the biggest opportunities to reduce specialty drug costs. |
|
|
Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
|
|
65,000+ retail pharmacy network Major chains and independents included. |
|
|
Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
|
|
835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
|
|
Flexible benefit design Prevent fraud, waste and abuse, for instance. |
|
| Custom formulary Drives lowest net cost. |
|
|
24/7 member support Both English and Spanish speaking staff. |
|
|
Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
|
|
Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
|
|
Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
|
|
Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
|
|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
TraditionalBusiness Model |
ReinvestmentBusiness Model |
FiduciaryBusiness Model |
Pass-ThroughBusiness Model |
TransparentBusiness Model |
|
|---|---|---|---|---|---|
|
Unrestricted access to group claims data Some PBMs restrict access to information because of its “proprietary” nature. |
|||||
|
Site of care management One of the biggest opportunities to reduce specialty drug costs. |
|||||
|
Invoice reconciliation Matching paid claims to invoices should not be time-consuming. |
|||||
|
65,000+ retail pharmacy network Major chains and independents included. |
|||||
|
Mail & Specialty pharmacy Cost plus pricing and reliable delivery. Provides a CMM or comprehensive medication management program. |
|||||
|
835 electronic remittance advice Allows plan sponsor to confirm amount reimbursed by the PBM to the pharmacy. |
|||||
|
Flexible benefit design Prevent fraud, waste and abuse, for instance. |
|||||
| Custom formulary Drives lowest net cost. |
|||||
|
24/7 member support Both English and Spanish speaking staff. |
|||||
|
Mobile application and web portal Available on Android and iOS with advanced protection, pharmacy locator, drug lookup and accumulator features. |
|||||
|
Rebate remittance reports Claim level detail on each claim manufacturers paid a rebate. Report includes NDC, date, claim number, Days supply, pharmacy identifier, quantity and amount paid. |
|||||
|
Pharmacogenomics program Program investigates how variations in genes affect response to medications. |
|||||
|
Alternative funding programs Includes patient assistance and copay maximization programs not limited in scope. |
|||||
|
Fiduciary standard of care Once a group goes live, PBM doesn’t adopt a rent-seeking behavior and is contractually obligated to contain its clients’ cost. |
THE TRANSPARENTRX WAY
Doing more for less.
Request a complimentary plan performance assessment report (PPAR)
a) Claims repricing
b) Contract and Benefit Design evaluation w/proprietrary scoring methodology
c) Rebate benchmarking
d) Learn how much you could save
Confirm pricing, performance guarantees and radical transparency
a) Interview or finalist presentation
b) Check references
c) Confirm project plan goals and timeline
d) Maximum effort to understand the big picture of client requirements
Roll out America's first fiduciary model PBM to employees and dependents
a) Experienced PBM team assigned
b) Clear expectations set with HR team and members during open enrollment
c) Pre and post implementation audits
d) Continuous monitoring
b) Clear expectations set with HR team and members during open enrollment
c) Pre and post implementation audits
d) Continuous monitoring
ORGANIZATION AND EMPLOYEE
PHARMACY BENEFITS CERTIFICATION PROGRAMS
Certified Pharmacy Benefits Specialist
Are you ready to increase your skillset around enhancing the pharmacy benefit experience? Consider becoming a CPBS!
Certified Pharmacy Benefits Leader
Are you ready to experience more confidence and fulfillment as well as a better ability to lead at work? Consider becoming a CPBL!
Certified Pharmacy Benefits Organization
Stand out among your competitors and show your stakeholders the unwavering commitment you have to pharmacy benefits management excellence!
TESTIMONIALS
What our clients have to say.
Jessica Woodward BrannDirector Employee Benefits
HORAN
“Wanted to let you know that our client service team has spoken with several Empire employees, and they have been singing the praises of the TransparentRx team. So much so that members are actually calling us back to tell us that your customer service team is terrific, super helpful, and they are very pleased. I know all to often vendors hear less than positive feedback so wanted to make sure that I share this as well. Please share with your team along with a big thank you for us for making us and Empire look good!”
Adam Berkowitz
Founder & President
Simpara
Simpara
“You have been a wonderful partner.
More to come!”
More to come!”
Brian UhligSenior Vice President
GCG Financial, LLC
“Tom, TransparentRx has been a great partner and as I mentioned on the phone done incredible work managing the spend for my client. It was a difficult transition as we didn’t have any existing claim files, but their team worked through the process and have delivered a 58% reduction in pharmacy spend from their previous program. I’ll leave it to the two of you to connect from here.”
Joe Pfannenstiel
Assistant Vice President
Benefit Management, LLC
Benefit Management, LLC
“TransparentRx is very organized. Thank you for a smooth implementation.”
Charonda McGill, GBA, CPBSVice President, Total Rewards
Lendmark Financial Services
Lendmark Financial Services
“I want to thank you so much for the knowledge, energy and passion you brought to the topics covered in the course. Your delivery was so electric! Not only was there never a dull moment in this course, the information shared was so eye opening. Throughout the class I kept saying to myself how can I have spent so much time managing employee benefit programs (over 20 years) and not have been aware of much of the material covered in this course. I thought I knew much more that I knew before I took this course. I feel so much more equipped now, though I am certain there is so much more to learn. If ever you consider offering other related courses, please let me know. I would love to consider enrolling.”
Doug SmithSenior Vice President
HealthPartners
HealthPartners
“I am grateful to you for helping my colleagues and me better understand the PBM business model and the pharmaceutical distribution system. I’m not sure whether or not you noticed, but we have implemented some significant changes in order to spotlight transparency and the pursuit of low net cost. Almost every day I happened upon an article which makes me think of you. In fact here’s another one! I hope you are doing well.”
Calculate your net savings
Organization And Employee
Pharmacy Benefits Certification Programs
Certified Pharmacy Benefits Specialist
Are you ready to increase your skillset around enhancing the pharmacy benefit experience? Consider becoming a CPBS!
Certified Pharmacy Benefits Leader
Are you ready to experience more confidence and fulfillment as well as a better ability to lead at work? Consider becoming a CPBL!
Certified Pharmacy Benefits Organization
Stand out among your competitors and show your stakeholders the unwavering commitment you have to pharmacy benefits management excellence!
MARKET VALIDATION
$597,000,000,000*
Total US prescription drug spending by 2025
1
Number of fiduciary model PBMs today
*Source: Kaiser Fmaily Foundation analysis of CMS Natinal Expenditure Data Histroical (Cy2005-2015) and Projected (CY2016-2025) Reatils Prescription Drug Expenditures.