FAQ's
General Questions
TransparentRx is a fiduciary Pharmacy Benefit Administrator (PBA). Unlike traditional PBMs that often profit from complex pricing models, we operate with radical transparency, focusing on removing conflicts of interest and holding ourselves contractually accountable to employer outcomes.
TransparentRx was founded in 2014. While we began our journey as a traditional Pharmacy Benefit Manager (PBM), we realized that the standard industry model simply didn’t go far enough to protect the financial interests of employers. Recognizing this gap, we pivoted our business model to focus on fiduciary pharmacy benefits administration. This change allowed us to move beyond basic transparency and offer a model that removes all conflicts of interest, ensuring we are contractually held accountable to employer outcomes.
A PBA (Pharmacy Benefit Administrator) is focused on the administration pipes of the pharmacy benefit, meaning eligibility files, claims processing, network access, member support, and reporting. In most cases, a PBA is paid a clear administrative fee to run the benefit and support the plan sponsor’s rules, rather than making money off the drug transaction itself. A PBM (Pharmacy Benefit Manager), on the other hand, typically operates as a profit-driven middleman that not only administers the benefit but also earns revenue from spread pricing, retained rebates, pharmacy and manufacturer fees, and specialty pharmacy steering. The practical difference is incentives: a PBA is usually built to reduce the employer’s net cost with clean compensation and stronger transparency, while a PBM often benefits financially when drug costs, utilization, or channel control increase.
We have corporate offices in Detroit, Michigan, and Las Vegas, Nevada.
A PBA (Pharmacy Benefit Administrator) is focused on the administration pipes of the pharmacy benefit, meaning eligibility files, claims processing, network access, member support, and reporting. In most cases, a PBA is paid a clear administrative fee to run the benefit and support the plan sponsor’s rules, rather than making money off the drug transaction itself. A PBM (Pharmacy Benefit Manager), on the other hand, typically operates as a profit-driven middleman that not only administers the benefit but also earns revenue from spread pricing, retained rebates, pharmacy and manufacturer fees, and specialty pharmacy steering. The practical difference is incentives: a PBA is usually built to reduce the employer’s net cost with clean compensation and stronger transparency, while a PBM often benefits financially when drug costs, utilization, or channel control increase.
For Employers & Plan Sponsors
We reduce costs through a combination of fiduciary oversight, elimination of hidden markups, aggressive specialty drug management, and AI-driven clinical rules. Our model ensures that employers pay what the pharmacy is actually reimbursed, with no hidden “spread.”
InsourceRx is our self-service dashboard that provides finance and HR teams with on-demand insights into Rx and J-code claims. It allows for defensible, data-driven decisions while keeping sensitive health information (PHI) secure within your own environment.
Yes. We offer RxDC Reporting Software that automates the complex CMS filing process by syncing data between PBMs, TPAs, and employers to help you avoid penalties and maintain compliance.
AFMS is our secure, automated data exchange platform. It uses secure SFTP protocols to connect PBMs and TPAs (Third Party Administrators), allowing for the seamless transfer of claims, accumulators, and eligibility data.
AFMS provides three primary benefits to employer groups:
- Improved Accuracy:By automating the exchange of eligibility and claims data, we eliminate the human errors associated with manual file uploads.
- Reduced Manual Labor:It removes the administrative burden from your HR and benefits teams, as the system handles data synchronization automatically.
- Data Integrity:AFMS enforces strict data integrity rules, ensuring that your plan’s financial accumulators (like deductibles and out-of-pocket maximums) are always up-to-date and accurate across all platforms.
Radical transparency requires accurate, real-time data. AFMS ensures that the data used for your analytics and fiduciary decisions is the most current and verified information available, preventing “leakage” or overpayments caused by outdated records.
For Members
Members can use our dedicated Member Portal and mobile application. This platform allows you to view claims, find pharmacies, and use AI-driven tools to make smarter, cost-effective decisions about your prescriptions.
Yes! We have fully integrated Mark Cuban Cost Plus Drugs into our member portal to ensure our members have access to the lowest possible prices on generic medications.
If you paid out-of-pocket for a prescription that should have been covered, you can find the Member Reimbursement Form under the “Members” or “Forms” section of our website.
Specialty & Clinical Services
Our Specialty Drug Management program is purpose-built to eliminate “markup games” and improve patient adherence. We provide full cost visibility and ensure these high-cost medications are used appropriately through strict clinical oversight. PAP, CAP, international mail-order, and 340B programs are all run in-house which increases efficiency and reduces costs.
TransparentPA™ is our cloud-based, HIPAA-compliant prior authorization (PA) workflow designed to reduce friction and speed up decision-making. It provides end-to-end visibility for members, providers, and HR teams, so everyone can track where a PA request stands from submission through approval or denial. The result is fewer delays, clearer communication, and faster access to needed medications.
Professional Development
The Certified Pharmacy Benefit Specialist (CPBS) is a professional credential offered through our partner ACoBS. It is designed for brokers, HR professionals, and consultants who want to master the complexities of pharmacy benefits and learn how to manage them transparently.
Yes, we offer a variety of resources including the PBM Insider blog, monthly newsletters, white papers, and virtual roundtable webinars to help industry professionals stay informed on the latest trends and regulations.