Frequently Asked Questions

What does it mean to carve-out?

What are the benefits of being carved-out?

Why should I carve-out with RxBenefits?

What information is required to complete a pharmacy analysis?

How long does it take to get a detailed analysis completed?

How do I know my client's information is safe?

What does it mean to carve-out?


Historically, employers have entrusted a health insurer to manage both medical and prescription benefits. Today, the trend for self-insured employers is to carve-out the pharmacy benefit and contract directly with a company like RxBenefits. This means the prescription benefit is separated from the medical benefit and managed by a different provider.

What are the benefits of being carved-out?


• Greater transparency in understanding the financial aspects of the pharmacy program.

• More control over the plan, including the ability to customize to a company’s unique needs.

• Better cost and trend management of both traditional and specialty drugs. Historically, pharmacy managers like RxBenefits have lower client drug trend by five to six percentage points compared to health plans. Factor in the compounding effect over time, and these savings become even more significant.

• Pharmacy is center of the desk.

• Better adherence to drug regiments due to  proprietary clinical tools and the use of 90 day purchase options resulting in better healthcare outcomes.

• Access to the best subject matter experts regarding all aspects of the pharmacy benefit including formulary, networks, utilization management, regulatory compliance and other clinical programs.

• The most innovative solutions pertaining to pharmacy benefits.

Why should I carve-out with RxBenefits?


Employers can get lost in the crowd at large PBMs. RxBenefits gives you the best of all worlds: the capabilities and competitive discounts of a best-in-class PBM coupled with our proprietary services and capabilities. With us, you have your own account management team, customer service, analysts, billing and IT support. We verify adherence to contract terms and commitments. In working with us, you gain the valuable expertise of pharmacy benefit specialists.

What information is required to complete a pharmacy analysis?


All we need is your pricing terms with rebate and admin information, claims file, and info on plan design. A copy of your contract would be helpful.

How long does it take to get a detailed analysis completed?


After your complete claim file is received, a detailed analysis is produced within 10 business days. Many times, we can provide a quick illustrative analysis based on reporting and contract details.

How do I know my client's information is safe?


RxBenefits takes the security of our clients’ confidential information very seriously. HIPAA policies are rigorously followed at all times in regards to managing access to the data. For outbound transfers, data from our system is sent via a secure channel using industry accepted encryption methods. For inbound data, RxBenefits requires providers to facilitate data transfer via secure methods (e.g., secure FTP). At all times, data is stored in a secure location with strict access controls. Data access is only allowed over secure (encrypted) channels.

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A comprehensive, focused approach results in pharmacy management success.

Even areas of pharmacy spend with low utilization can drive a disproportional amount of cost. For example, while approximately 1% of members utilize specialty medications, these expensive drugs comprise 30% of healthcare costs. By partnering with a knowledgeable and agile pharmacy partner, such as RxBenefits, employers can leverage pharmacy benefits to achieve healthy cost and care outcomes.