Solutions

OptimizedRx gives brokers and self-funded employers access to premier GPO-level PBM contracts, flexible rebate models, importation, specialty and GLP‑1 cost strategies, long-term analytics, and transparent performance validation — all without replacing the broker relationship or acting as a PBM.

PBM Pricing & Aggregation

We provide access to enhanced PBM contract terms normally available only to the largest purchasing coalitions — without requiring any change to the broker relationship.

Our GPO contracts deliver improvements across:

• Ingredient cost discounts

• Rebate structures and guarantees

• Specialty-drug terms

• Network discounts

• Administrative fees

• Transparent, client-aligned contract language

Savings Validation & Reconciliation

We establish structured savings expectations and provide transparent reconciliation to validate actual contract performance.

Includes:

• Pre-implementation benchmarking

• Defined savings expectations

• Annual reconciliation and variance reporting

• Employer-ready documentation

Specialty & GLP-1 Cost Strategy

Specialty drugs and GLP‑1 therapies drive a disproportionate share of pharmacy spend. We help brokers evaluate exposure and deploy cost‑reduction strategies through vetted partners.

Includes:

• GLP‑1 alternative therapy pathways

• Vetted compound options (where compliant)

• International sourcing partners (plan-dependent)

• Specialty-drug optimization and forecasting

Analytics & Reporting (PowerBI)

Our analytics platform provides multi-year visibility even when clients change PBMs.

Includes:

• Multi‑year trend dashboards

• GLP‑1 and specialty‑drug forecasting

• Rebate performance visibility

• PBM benchmarking

• Utilization and plan‑risk insights

• Custom KPI dashboards

PBM Term Verification & Technical Support

We ensure GPO PBM contract terms are implemented correctly without acting as a PBM or TPA.

Includes:

• Verification of PBM‑loaded contract terms

• Coordination with PBMs for alignment

• Monitoring pricing and guarantee compliance

• Escalation of contract discrepancies

We do NOT manage claims, eligibility feeds, HRIS systems, or PBM operations.

Rebate Models & Administration Options

OptimizedRx uniquely unlocks pass‑through rebate models—even with major PBMs like Optum and CVS—while also supporting traditional and hybrid rebate structures with guaranteed monthly credits. This protects employer cash flow and solves the common rebate-credit gap brokers face during PBM carve-outs giving brokers capabilities normally unavailable directly from PBMs.

Pass‑Through Rebates (Available with Optum, CVS, and others):

• Full rebate pass‑through

• No opaque retention

• Full audit visibility

Traditional Rebate Models:

• Predictable guaranteed rebate rates

• Integrated GPO terms

Hybrid Guaranteed Monthly Credit:

• Replaces lost carrier rebate credits during carve‑outs

• Employer receives a guaranteed monthly rebate credit funded by OptimizedRx

• Year‑end true‑up against actual rebate performance

• OptimizedRx absorbs negative variance if rebates fall short

• Employer receives surplus rebates if higher

• Employers always measure savings on net basis

This protects employer cash flow, stabilizes monthly budgets, and avoids the ‘rebate credit shock’ brokers often overlook.

Ready to strengthen your PBM strategy with better pricing, flexible rebate structures, and full transparency?

Request a Savings Analysis

Schedule a Broker Briefing

(888) 329-2199 | info@optimized-rx.com

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