Exploring Transparency-Rx’s pharmacy benefit manager partners

March 18, 2024 - Transparency-Rx is a recently launched organization of transparent pharmacy benefit managers working towards addressing the ongoing challenges with pharmacy benefit managers (PBMs) that have hindered access to care and significantly increased healthcare spending.

“We just launched in September last year as a formal business coalition. Our goal is really to highlight to Congress and other stakeholders [how] sound drug policies can create a more competitive environment that allows choice and an open market to take place, as well as lower costs for patients and plans,” explained Joseph M. Shields, Esq, Managing Director of Transparency-Rx in a recent media briefing.

The main goal of this collaboration is to identify reduced drug costs hidden by the current PBM landscape, which critics say impedes competition and drives up pharmaceutical prices. According to the organization’s website, they focus on national drug price transparency through issue-based work that highlights true drug prices, promotes a level playing field without conflicts of interest, prioritizes information and data sharing, and increases and enforces fair disclosures on revenues.

“One of the key aspects of the work that we're doing [is to] provide employers a key line of sight into their spend. There's better reliability in terms of both the data that's provided and also the sort of expectations among clients. As a result of that, a more trusted, coherent relationship that often comes out of an engagement with a transparent PBM that you don't see in larger with the larger competitors,” added Shields.

At the time of publication, Transparency-Rx has seven members that cover about 15 million individuals nationally. Shields explained that if Transparency-Rx acted as a PBM, it would be the fourth largest PBM in the US. Its transparent PBM partners include SmithRx, Liviniti, AffirmedRx, RxPreferred, Navitus Health Solutions, Pharmacy Benefit Dimensions, and MedOne.

In this article, PharmaNewsIntelligence explores claims made by these transparent PBMs, gathering insight from publicly available information and a Transparency-Rx media briefing call.

AffirmedRx

AffirmedRx is a public benefit corporation that functions as a transparent PBM. The company’s primary pillars include total clarity, clinical focus, and state-of-the-art technology.

AffirmedRX is also a public benefit corporation, which is a company that generates social and public good and operates in a responsible and sustainable way.

“We are the only PBM structured as a Public Benefit Corporation or PBC. This means we prioritize patient needs and health outcomes ahead of pursuing the traditional C-Corp goals of profit generation. Due to this unique business structure, our Board of Directors and our executives make decisions based on public benefit without fear of liability, even if that results in less profit,” it notes on the website.

Liviniti

Liviniti, previously called Southern Scripts, is a PBM involved in the Transparency-Rx coalition. The company, led by pharmacists and guided by industry knowledge, refers to itself as a thought leader instead of an industry follower.

It offers multiple PBM services, including clinical services, prior authorization programs, drug formulary options, retail pharmacy networks, mail order and specialty networks, rebate procurement, customer portals and a mobile app, robust reporting, and a variable copay program. It serves companies with 100–100,000 employees.

Liviniti focuses on clarity by charging a single admin fee to cover standard services and translating all the drug rebates to the client rather than retaining some of the rebates.

MedOne

MedOne also functions differently from traditional PBMs. The company notes that it is transitioning from standard fee-for-volume pharmacy benefits to a fee-for-value approach.

The company works by accessing direct contracts with pharmacies and manufacturers to negotiate drug prices. It also pays attention to negotiations, focusing on the prescriptions and where they are being filled.

Clients can collaborate with MedOne to create a strategy that works based on the client’s needs. It claims its member-centric execution strategy helps it save 25% more than industry standards.

Navitus Health Solutions

Navitus Health Solutions launched as a PBM in 2003 with three main goals: 100% pass-through, lowest net costs, and excellent clinical care.

The 100% pass-through policy focuses on passing all discounts and rebates to their clients. The company’s data states that within one year of implementing this approach, a client that covers 35,000 members can save up to $7 million in the first year.

“What we charge our clients is what we pay the pharmacies and what we receive in terms of rebates, regardless of how they're categorized, go back to the plan sponsors,” noted David Fields, President and CEO of Navitus Health Solutions, in the briefing.

The company emphasizes that its lowest net cost philosophy begins by ensuring that formulary decisions are clinically sound. Then, it focuses on formulation management and drug mix to reduce net costs for its clients.

Finally, the company’s philosophy prioritizes excellent clinical care through clinical care models that utilize claims data.

“Having access to that data allows them to understand where their money is being spent and where are the opportunities to maybe enhance the benefit, lower a premium, lower a copay, or where do they need to be tighter in their overall management and it creates an overall new consultative approach,” Fields added.

Pharmacy Benefit Dimensions

Pharmacy Benefit Dimensions notes that it functions as a PBM that prioritizes getting the proper prescriptions to patients at the appropriate time and the lowest costs.

The company’s website notes that it assists clients in the entire process, from answering member questions to communicating directly with pharmacists at the point of sale, to serve over 4,000 employer groups nationally.

RxPreferred

RxPreferred Pharmacy Benefit Administration is another transparent PBM part of the Transparency-Rx coalition. The organization offers customizable PBM services for health plans, hospitals and health systems, self-funded employers, brokers, consultants, and third-party administrators.

Like the other PBMs on this list, RxPreferred follows a 100% pass-through policy for prescription drug claims processing and returns 100% of the rebates to the client. Beyond that, it offers services, including collaborative and customized plan designs and drug utilization reviews, with a zero conflict-of-interest strategy.

The company attributes its 98.8% client retention rate to its client-centric approach and “white glove customer service.”

SmithRx

SmithRx markets itself as a simplified PBM with a primary goal of reducing the complexity and costs associated with pharmacy benefits. The company has a 99% client retention rate, which it attributes to its consistent cost savings and minimum member disruptions.

“Nine years ago, I started SmithRx with the mission of creating a new pathway forward for pharmacy benefit administration. I saw this as the most complex area of US healthcare plan delivery, and it shouldn't be,” noted Jake Frenz, founder and CEO of SmithRx, in the briefing. 

Unlike traditional PBMs, SmithRx controls and minimizes drug costs for self-insured companies using 100% pass-through pricing. Rather than making money from the supply chain by charging sponsors more than what is paid to the pharmacy, SmithRx says sponsors pay precisely what the pharmacy charges for their drugs.

Editor's Note: This article has been edited to change all mentions of Navitus to Navitus Health Solutions.