Press Releases

Smoke and Mirrors: Why Reporting Still Falls Short in Pharmacy Benefits, and What to Do About It

Thu, 02 Apr 2026 17:56:29 GMT

Smoke and Mirrors: Why Reporting Still Falls Short in Pharmacy Benefits, and What to Do About It

Employers are not short on pharmacy data.

Most receive detailed reports, dashboards, and quarterly reviews from their PBM. On paper, it looks like everything is covered. There are charts, trend lines, and summaries that suggest a clear picture of performance.

But when benefits leaders sit down to make a decision, the same questions tend to surface:

Why are our costs rising?

Where are we overspending?

Are we actually getting the value we were promised?

If the reporting were doing its job, those answers would be obvious. Too often, they are not.

The Problem with Traditional PBM Reporting

Traditional PBM reporting was not designed for today’s level of scrutiny. Many of these reporting models were built years ago, when employers were less involved in the day-to-day management of pharmacy spend. The goal was to provide a general update, not to enable deep analysis or real-time decision-making.

That approach has not kept up with how complex pharmacy has become.

Today, employers are dealing with high-cost specialty medications, shifting rebate structures, multiple vendors, and pressure to justify every dollar spent.

Yet the reporting they receive often stays at a surface level.

You may see summarized rebate totals, blended pricing, and high-level utilization reports with little context. The Federal Trade Commission has noted that limited transparency in PBM pricing can make it difficult for plan sponsors to understand how money flows through their programs.

So while reports look complete, they often leave out what matters most.

When Data Exists but Insight Is Missing

In many cases, the issue is not that information is unavailable. It is that the information is not usable.

Employers often receive large data sets without the tools or context to interpret them. Reports arrive late, and by the time something stands out, the opportunity to act has passed. This creates a cycle of reacting instead of managing.

Common challenges include reports that show what happened but not why, limited ability to drill into claims, and disconnected data across systems. The result is a lack of clarity when it is needed most.

What True Business Intelligence Should Look Like

Business intelligence should do more than summarize the past. It should help shape what happens next.

That means real-time visibility, claim-level transparency, and actionable insights.

Employers should be able to see trends as they happen, understand each claim, and use that information to guide decisions.

If reporting does not lead to action, it is not doing enough.

Moving Away from “Smoke and Mirrors”

The phrase reflects a real concern in the PBM space.

Complex pricing, delayed reporting, and limited visibility make it difficult to see what is happening behind the scenes. This creates a gap between trust and verification, where costs and performance are hard to fully evaluate.

A better approach to pharmacy reporting is simple in concept. Employers should be able to see their data clearly, in real time, and down to the claim level without relying on layers of interpretation.

That means access to auditable claims, transparent pricing, and tools that turn data into action, not just reports. Platforms like ClearSight Transparency are built around this idea, giving employers a direct view into the details behind their pharmacy spend.

This matters because pharmacy spend is too significant to manage in hindsight. When benefits leaders can see what is happening as it unfolds, they can identify cost drivers, adjust strategies, and hold partners accountable.

For years, complexity has made it difficult to fully understand pharmacy programs. That is where the “smoke and mirrors” take hold.

As expectations shift, so does the standard.

Employers are no longer asking for summaries. They are asking for clarity. And with that clarity comes the ability to manage pharmacy benefits with confidence.

Sources:

Federal Trade Commission. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies (Interim Staff Report, July 2024). https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf

U.S. Government Accountability Office, Medicare Part D: Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization https://www.gao.gov/products/gao-19-498

KFF Health News, “Employers Haven’t a Clue How Their Drug Benefits Are Managed.” https://kffhealthnews.org/news/article/employer-drug-benefits-pbms-survey-kff

KFF Health News, “PBM Math: Big Chains Are Paid $23.55 To Fill a Blood Pressure Prescription. Independent Drugstores Get $1.16.” https://kffhealthnews.org/news/article/pbm-pharmacy-benefit-managers-independent-drugstores-versus-big-chain-prices

What Rebate Pass-Through and New Reporting Rules Mean for Plan Sponsors

Tue, 03 Mar 2026 20:25:51 GMT

In early 2026, Congress passed sweeping pharmacy benefit manager reform as part of the federal budget package. While the law includes several provisions, two stand out for employers and benefits leaders:

Mandatory 100% rebate pass-through
New detailed reporting requirements

These changes are designed to bring more transparency and alignment to how pharmacy benefits are managed. For employers, they create both opportunity and responsibility.

Let’s break down what this means in plain terms.

What Is Rebate Pass-Through?

When a drug manufacturer pays a rebate, it is usually tied to a drug’s placement on a formulary or overall utilization. Historically, PBMs negotiated these rebates. But the way those dollars flowed back to employer plans was not always clear.

Under the new federal law:

PBMs must pass through 100% of rebates, fees, and price concessions they receive from drug manufacturers to the health plan.
Rebates can no longer be retained as hidden revenue.
Payments must be remitted on a regular schedule.

In simple terms, the rebate dollars tied to your plan must now go back to your plan.

Why This Matters

Rebates have long been one of the most misunderstood parts of pharmacy benefit management.

Employers often saw a rebate check but had limited visibility into:

The total rebate amount negotiated
Any fees retained by the PBM
The true net cost of the drug after all concessions

Full pass-through changes the incentive structure. Instead of revenue being tied to rebate retention, compensation shifts toward clearly defined service fees.

That is a significant structural change.

What About the New Reporting Requirements?

The second major reform is transparency.

PBMs must now provide employer health plans with detailed reporting that includes:

Gross drug spend vs. net drug spend
Total rebates, discounts, and fees received
Spread pricing information
Member out-of-pocket cost data

Reports must be provided at least semiannually, and in some cases quarterly upon request.

For plan sponsors who take their fiduciary responsibilities seriously, this is a big development.

Why Reporting Changes Everything

Data changes conversations. With more standardized reporting, benefits leaders can better answer key questions:

Are we paying a fair net price?
Is our PBM’s compensation aligned with our goals?
Are member out-of-pocket costs improving or rising?
Are specialty trends being managed appropriately?

Transparency does not automatically lower costs. But it does give employers the tools to evaluate performance in a more objective way.

What Employers Should Do Now

Although implementation is phased in over several years, benefits leaders should begin preparing now.

1. Review Your Current PBM Contract

Understand:

How rebates are currently structured
Whether you are already on a 100% pass-through model
What reporting rights you currently have

Not all “transparent” contracts are created equal.

2. Define What Success Looks Like

Rebate pass-through is important. But net cost matters more.High rebates do not always equal lower overall spend. The goal should be total cost control, improved outcomes, and better member experience.

3. Prepare to Use the Data

Receiving reports is one thing. Knowing how to interpret them is another.

Benefits leaders may need:

A standardized internal review process
Independent analytics support
A clearer dashboard that separates gross, net, specialty, and trend data

Transparency only works if it is acted upon.

The ProCare Rx Perspective

At ProCare Rx, transparency has never been a trend. It has been a foundation.

Long before federal reform required 100% rebate pass-through and detailed reporting,
ProCare Rx built its model around:

Clear rebate structures
Defined service fees
Straightforward net cost reporting
Clinical programs that focus on total drug spend, not just rebate volume

The goal is simple: align incentives with employer outcomes.

Rebates matter. But real pharmacy value is measured by overall cost control, member safety, and thoughtful clinical oversight.

As federal reforms roll out over the next several years, employers should not just ask, “Are we compliant?” They should ask, “Are we aligned?”

Transparency is no longer optional in this industry. It is the new standard. And for employers who want to lead, not just react, this is an important moment to evaluate whether their PBM model truly supports their long-term strategy.

SOURCES:

https://www.sidley.com/en/insights/newsupdates/2026/02/congress-passes-significant-federal-pharmacy-benefit-manager-reform-impacting-pharmaceutical-market

https://www.mintz.com/insights-cen t er/viewpoints/2146/2026-02-06-congress-passes-landmark-pbm-reform-2026-spending-bill

https://hallrender.com/2026/02/05/federal-pbm-reform-is-here-unpacking-key-provisions-of-the-landmark-legislation/

https://www.sentinelgroup.com/resource-center/2026/congress-passes-pbm-reform-caa-2026

ProCare Rx Appoints Rodney Hardin as VP, Sales

Mon, 09 Feb 2026 14:55:24 GMT

ProCare Rx Appoints Rodney Hardin as VP, Sales

This appointment brings a renewed focus on our clients and prospects in the Northeastern US, to best serve our PBM clients and members, assuring that ClearSight transparency, Clinical Effectiveness and Lowest Net Cost remains at the forefront of the innovative organization.

Gainesville, GA, February 9, 2026 - ProCare Rx is proud to announce Rodney Hardin has joined our PBM Team as VP, Sales, focused on the Northeastern US. For more than 30 years he has been advocating the value of ProCare Rx’s message and relationships, across the healthcare and services continuum. This new role will increase access and support to self-insured employers and broker/consultants in the territory.

“We are excited to welcome Rodney to the ProCare Rx team. With diverse experience he is going to bring client perspective and insight to our customers in the Northeast, as we move forward with our new messaging,” said John Drakulich, President of ProCare Rx’s PBM business unit

Hardin brings experience and insight from Drexi, a privately held PBM, where, as VP of Sales, he provided sales strategy and process while delivering value to accelerate growth. Prior to that he held sales and customer strategy roles at Liviniti, Northwestern Mutual, Kroger Prescription Plans, Avon, Toyota USA, and FedEx.

“I am excited to join ProCare Rx and build the new regional territory, while building relationships with new and established clients in the commercial self-insured employer market, ” said Hardin.

Rodney holds a BS in Business Administration and Management from Kentucky State University, and is an active Board Member of both the Workforce Council of Southwest Ohio and Crayons to Computers focusing on providing tools for success in local schools. He resides in Cincinnati, OH.

Why the PBM Switch Is the Quiet Power Behind Pharmacy Benefits

Fri, 06 Feb 2026 18:14:30 GMT

When people think about pharmacy benefit managers, they usually think about drug prices, formularies, or rebates. Rarely do they think about technology. Yet behind every prescription filled at the pharmacy counter is a system working in real time to make sure the claim is processed correctly.

One of the most important parts of that system is the switch .

It is not something members see, but it plays a major role in how smooth or stressful the pharmacy experience feels. As benefits leaders look ahead to 2026, understanding the role of the switch helps explain why technology decisions matter more than ever in the PBM space.

What the Switch Actually Does

At its core, the switch acts like a translator and traffic controller.

When a prescription is submitted, the switch moves information between the pharmacy, the PBM, and the health plan. It checks eligibility, applies plan rules, calculates pricing, and sends an approval or rejection back to the pharmacy, often in just a few seconds.

When this process works well, the member barely notices it. When it does not, the result can be delays, confusing messages, or unexpected out-of-pocket costs. The switch may be invisible, but its impact is felt immediately.

Why the Switch Is Often Overlooked

Many PBMs do not own or control their switch. Instead, they rely on outside vendors to manage that flow of information. Over time, this creates layers of systems that were not designed to work together.

When something goes wrong, it can be difficult to pinpoint the issue. Data may not line up cleanly, fixes can take longer, and the experience becomes fragmented for everyone involved. These challenges rarely show up in a proposal, but they show up quickly at the pharmacy counter.

A More Integrated Approach to PBM Technology

ProCare Rx takes a more integrated approach by managing its switch alongside its claims processing platform. This matters because the systems are designed to work together from the start, rather than being connected after the fact.

With this structure, data flows more cleanly and issues can be identified faster. Rejected claims are easier to understand, pricing logic is clearer, and pharmacies can get answers without unnecessary handoffs. Security is also stronger when fewer external systems are involved.

This kind of integration supports simplicity without sacrificing sophistication. The technology may be complex behind the scenes, but the experience is designed to feel straightforward for members and plan sponsors.

How the Switch Shapes the Member Experience

While members may never hear the word “switch,” they experience its results every time they pick up a prescription.

A well-managed switch helps reduce unnecessary claim rejections and supports clearer cost information at the point of sale. It can also help guide members toward better pricing options when discounts or coupons are available. These moments matter, especially when members are already dealing with health concerns.

Small improvements in the technology layer often lead to big improvements in trust and satisfaction.

Why This Matters Now

Pharmacy benefits are not getting simpler. New medications, pricing models, and regulatory pressures continue to add complexity. In this environment, foundational technology becomes critical.

PBMs that invest in core infrastructure, like the switch, are better positioned to adapt, respond, and deliver clarity. They are also better equipped to support employers who want transparency and plan members who want fewer surprises.

The switch may be one of the most powerful parts of a PBM. And as we launch into 2026, benefits leaders are beginning to look beyond surface-level features and pay closer attention to what is happening behind the scenes.

ProCare Rx Appoints Craig Abrahamson as VP, Consultant Relations

Thu, 18 Dec 2025 14:12:40 GMT

ProCare Rx Appoints Craig Abrahamson as VP, Consultant Relations

Gainesville, GA, December 15, 2025 - ProCare Rx is proud to announce Craig Abrahamson has joined our PBM Team in the newly created role of VP, Consultant Relations. As a 25-year healthcare veteran with deep understanding of the consultant infrastructure, Craig steps into this newly created role to enhance ProCare Rx’s message and relationships with the large consultant community

“We are proud to welcome Craig to the ProCare Rx team. His experience across the health benefits spectrum brings new insight to our go forward strategy and initiatives. He brings a unique combination of technical expertise and insight to our organization,” said John Drakulich, President of ProCare Rx’s PBM business unit

Abrahamson was previously at BeneCard PBF, a privately held PBM, where, as Sales Director, he provided self-funded solutions to public and private employers of all sizes, offering a full suite of actuarial, compliance, financial, and producer services. Prior to that he held business development and strategy roles at RxBenefits, SCIO Analytics, OptumHealth Insights, United Healthcare, and WellPoint.

“I am excited to join ProCare Rx at this critical juncture, and look forward to helping build and grow relationships with consultants and channel partners to accelerate our presence in the commercial self-insured employer market.”

“Consultant relations is a critical part of our go forward strategy,” said Drakulich, “Creating this new role with Craig is going to shape our positioning with large consultants and channel partners as a transparent and accountable PBM.”

Craig is a Certified Self-Funding Specialist, holds an MBA from the University of Hartford and a BA in Political Science and Government from the University of Connecticut. He resides in Connecticut with his wife and family.

About ProCare Rx

ProCare Rx, a privately-held, national leader in pharmacy benefit management services, focused on pharmacy claims processing, and clinical program design, empowering healthcare organizations since 1988. The primary goal is lowering net cost while improving patient health. Based in Gainesville, GA, we provide customizable, cost-effective solutions tailored to the

unique needs of self-insured employer groups, TPAs, pharmacies, health plans/systems, unions, and other industry leaders. Our commitment to ethical, transparent operations and long-lasting partnerships has made us a trusted partner in optimizing pharmacy benefits and clinical performance. To learn more about how ProCare Rx is bridging the gap between cost savings

and clinical innovation, visit http://www.ProCareRx.com

Media Contact:

Marc Cohen, SVP, Marketing

marketing@ProCareRx.com

The New Reality of Direct-to-Consumer Drug Marketing

Tue, 02 Dec 2025 20:20:43 GMT

The New Reality of Direct-to-Consumer Drug Marketing

Direct-to-consumer (DTC) drug advertising has grown fast, and it is changing how employees think about their medications. In the U.S., the top 10 pharmaceutical companies spent an estimated $13.8 billion on advertising and promotions in 2023 alone, with much of it targeting consumers directly.

For benefits leaders, this trend matters. It affects pharmacy spend, member expectations, and the way new drugs enter the market.

What’s Driving the Surge

Three forces are fueling this shift:

1. Digital reach.
People spend more time online and on social media than ever. This makes it easier for drug makers to reach individuals directly.

2. Consumer trust in online health information.
Studies show that many adults turn to the internet or social feeds for health info before talking with a doctor.

3. Higher awareness of new therapies.
While awareness can be positive, the rise in DTC ads often promotes high-cost brand-name drugs , even when lower-cost or equally effective options exist. For example, a study found that since 1996 annual DTC advertising budgets in the U.S. grew from about $1.3 billion to around $6 billion by 2016.

Why It Matters to Employers

Growing DTC marketing leads to:

Higher pharmacy costs , as demand increases for branded drugs.
Pressure to expand formularies to include drugs that members ask for—even when they may not be preferred.
Confusion and misinformation , because members may believe something is the “best” choice based on an ad, not clinical evidence.
Equity gaps , since DTC ads and digital access tend to favor people who are tech-savvy and higher income.

How PBMs Help Counter the Trend

Pharmacy benefit managers now play a bigger role in balancing value, access, and member expectations. They use:

Data and analytics to detect when DTC marketing is driving unusual prescribing trends.
Evidence-based formularies that protect against unnecessary cost.
Member education and counseling that explains therapeutic alternatives and cost implications.
Clinical review tools like prior authorization and step-therapy to ensure medications are appropriate before heavy cost is incurred.

These strategies help keep decisions grounded in clinical value instead of marketing influence.

What Benefits Leaders Can Do

Here are three practical next steps:

Partner with a PBM that actively monitors DTC trends and supports member education.
Ensure communication materials help members understand generics and lower-cost options, not just the brand-name drugs they hear about on TV.
Focus on value, outcomes, and equitable access, not just formulary expansion or rebate chasing.

DTC marketing isn’t going away. By staying informed and proactive, benefits leaders can help members make choices based on what truly supports their health and the organization’s financial goals.

Sources

America’s Health Insurance Plans (AHIP) , New Reports Spotlight Drugmakers’ DTC Ad “Spending Spree” https://www.ahip.org/news/articles/new-reports-spotlight-drugmakers-dtc-ad-spending-spree

Johns Hopkins Bloomberg School of Public Health, Spending on Consumer Advertising for Top-Selling Prescription Drugs in U.S. Favors Those With Low Added Benefit
https://publichealth.jhu.edu/2023/spending-on-consumer-advertising-for-top-selling-prescription-drugs-in-us-favors-those-with-low-added-benefit

Journal of General Internal Medicine, Dangers and Opportunities of Direct-to-Consumer Advertising https://pmc.ncbi.nlm.nih.gov/articles/PMC5910355

The Next Wave of PBM Reform: What It Means for Employers and Plan Sponsors

Tue, 04 Nov 2025 19:05:31 GMT

The Next Wave of PBM Reform

Across the country, prescription-drug reform is taking center stage again. Over the past few months, both federal agencies and state legislatures have been rolling out new proposals aimed at reshaping how pharmacy benefit managers (PBMs) operate.

At the same time, PBMs themselves are beginning to respond, proactively changing business practices in hopes of staying ahead of pending regulation. For benefits leaders, the result is a landscape in motion, with real implications for cost, compliance, and care access.

PBMs Move Before Regulators Do

In late September, several large PBMs proposed internal reforms to improve pricing transparency and network accountability. These proposals range from enhanced reporting of pharmacy reimbursements to optional “clean claim” models that strip away spread pricing and rebate layers.

The timing is no coincidence. With scrutiny from policymakers and the public at an all-time high, PBMs are trying to show that the industry can modernize without heavy-handed oversight. Whether these self-directed moves are enough remains to be seen, but the shift signals one clear trend: the traditional PBM model is evolving fast.

States Step in to Regulate Drug Costs

At the same time, state lawmakers are not waiting for Washington. Nearly two-thirds of states have passed or introduced legislation this year designed to tackle prescription-drug costs—and most of those laws include PBM-specific provisions.

Some states are introducing audit requirements and turnaround-time standards. Others are imposing fee caps, rebate reporting, or “fair reimbursement” rules for pharmacies. While these efforts share the goal of protecting patients and local pharmacies, the patchwork of regulations creates new complexity for national and multi-state employers.

For plan sponsors, that means your PBM contract (and your overall pharmacy strategy) must be nimble enough to navigate multiple jurisdictions and pricing frameworks at once.

What Employers Should Be Watching

Benefits leaders should keep an eye on three key areas in the months ahead:

Network stability: Rapid changes in reimbursement rules can affect which pharmacies stay in network and at what cost.
Transparency requirements: Employers should expect more detailed reporting obligations, both from PBMs and state regulators.
Plan compliance: The more fragmented the state landscape becomes, the greater the need for centralized oversight of claims and payments.

Each of these factors influences your bottom line and your plan members’ experience at the pharmacy counter.

Sources:

Stateline, “Dozens of states tackle high prescription drug costs,” October 30, 2025 — https://stateline.org/2025/10/30/dozens-of-states-tackle-high-prescription-drug-costs/
MassMarketRetailers, “NACDS calls PBM plan ‘self-policing,’” September 25, 2025 — https://massmarketretailers.com/nacds-calls-pbm-plan-self-policing/
Becker’s Hospital Review, “PBMs draft plan to change business practices: 4 things to know,” September 24, 2025 — https://www.beckershospitalreview.com/pharmacy/pbms-draft-plan-to-change-business-practices-4-things-to-know/

Reuters, “Pharma middlemen propose regulatory changes to avoid regulations,” September 24, 2025 — https://www.reuters.com/business/healthcare-pharmaceuticals/pharma-middlemen-propose-changes-avoid-regulations-trump-administration-2025-09-24/

PBM 101, Part 2: Choosing the Right PBM in a Time of Rising Costs and Changing Rules

Wed, 01 Oct 2025 16:58:52 GMT

Drug costs continue to surge, regulatory winds are shifting, and employers are bracing for steeper expenses ahead. Now more than ever, your choice of PBM partner can be a major differentiator or a liability.

Why This Moment Matters

Cost growth expectations are steep. Employers are forecasting higher health care costs in 2026, with pharmacy spend as a central contributor. Some projections suggest pharmacy alone may rise by double digits next year, far outpacing general medical cost trends.

Reform pressure is building. PBM practices are under increasing scrutiny. Policymakers, physician groups, and pharmacy organizations are pushing for reforms that would delink PBM profits from drug list prices, increase transparency, and ensure savings flow to plan sponsors and patients. PBMs themselves are already floating proposals to adjust their practices ahead of possible legislation.

Regulation is becoming inconsistent and complex. While federal courts and Congress weigh in, states continue to pass new PBM laws. For multi-state employers, this means navigating a patchwork of rules that can be confusing, sometimes conflicting, and potentially at odds with fiduciary obligations.

What to Look for in a PBM Partner

Given this evolving landscape, employers should place extra emphasis on:

Regulatory agility and compliance support
Your PBM must help you navigate both federal and state-level requirements, protecting your plan against compliance risk.
True cost transparency and incentive alignment
Demand clarity on how your PBM is compensated. Incentives should be aligned with your plan, not tied to higher drug list prices or opaque rebate arrangements.
Formulary integrity and clinical governance
With expensive therapies hitting the market, your PBM should balance cost savings with clinical appropriateness, ensuring members receive the right drug, not just the cheapest option.
Benefit design flexibility
Rising costs require innovative plan designs such as specialty carve-outs, differential cost-sharing, or utilization management. Your PBM should be a partner in shaping these strategies, not a barrier.
Member experience and adoption tools
With members facing higher cost-sharing and more complex therapies, digital tools, adherence programs, and proactive engagement are essential for better outcomes.
Proven performance and benchmarking
In this climate, results matter. Your PBM should demonstrate measurable cost savings and clinical outcomes year over year, benchmarked against peers.

The Bottom Line

Plan sponsors are entering a pivotal moment. The forces shaping pharmacy benefits include cost escalation, regulatory change, and clinical complexity. The status quo will not be enough.

Choosing a PBM partner with regulatory foresight, aligned incentives, clinical integrity, and member-centric tools can help employers navigate this era, mitigate risk, and deliver sustainable value to their workforce.

Sources

The New Pharma Playbook: Trends Employers and Health Plans Can’t Ignore

Mon, 29 Sep 2025 16:18:07 GMT

The world of pharma is evolving quickly, with direct-to-consumer (DTC) marketing and new patient engagement strategies changing how therapies are launched, prescribed, and accessed.

Join John Drakulich for an insightful conversation on The New Pharma Playbook and what these shifts mean for employers, health plans, pharmacies, and patients.

Hosted by ProCare Rx , this webinar takes a closer look at how DTC marketing influences prescribing behavior, patient decision-making, and overall drug costs, and how transparent PBM strategies can help plan sponsors navigate these challenges while prioritizing member care. Attendees will walk away with practical insights into how PBMs like ProCare Rx are driving innovation, improving access, and keeping costs under control in a changing marketplace.

PBM 101, Part 1: Why PBMs Matter for Employers

Fri, 05 Sep 2025 15:51:17 GMT

PBM 101, Part 1: Why PBMs Matter for Employers

Pharmacy costs continue to climb, putting pressure on employers and plan sponsors to do more with less. A recent survey found that 51% of large U.S. employers plan to shift more healthcare costs to workers in 2026 , with prescription drugs - especially GLP-1 and specialty medications - being the main driver.

Amid these challenges, many are asking: what role does a pharmacy benefit manager (PBM) actually play?

Let’s start by looking at what a PBM is.

A pharmacy benefit manager is not an insurance company. Instead, PBMs administer the prescription drug portion of health benefits by:

Processing and paying prescription claims
Negotiating prices with pharmacies
Developing formularies - the list of drugs covered by the plan
Offering rebate programs to help offset costs

In short, a PBM ensures that members can access needed medications while helping employers control spend.

Why It Matters

PBMs do more than process transactions. The right partner can:

Encourage generics and lower-cost options when appropriate
Build pharmacy networks that lower costs while improving access
Monitor prescription safety and reduce medication errors
Provide technology tools for easier refills, adherence, and reporting

For plan sponsors, understanding what a PBM does is the first step. In today’s environment of rising costs and new therapies, it is also the first step toward selecting the right partner.

Next in this two-part PBM 101 series: how rising drug costs are reshaping the role of PBMs, and what to look for in a PBM partner.

Sources- https://www.reuters.com/legal/litigation/many-us-employers-plan-pare-health-benefits-weight-loss-spending-soars-2025-07-16/

ProCare Rx appoints Marco Torelli as new SVP of Labor and Public Sector

Thu, 28 Aug 2025 14:57:54 GMT

ProCare Rx appoints Marco Torelli as new SVP of Labor and Public Sector

Gainesville, GA — [Date], 2025 — ProCare Rx is pleased to announce that Marco Torelli has joined the company as Senior Vice President of Labor and Public Sector . In this role, he will lead national strategies to expand ProCare’s presence across union, labor, and public sector markets, bringing more than 20 years of pharmacy benefit management and healthcare sales experience.

Torelli most recently served as Vice President of Pharmacy Benefits Business Development at HealthTrust Performance Group , where he oversaw sales and marketing strategies to drive growth and market share.

He previously held senior leadership positions at Citizens Rx, WellDyneRx, Labor First, and OptumRx , with a focus on developing tailored solutions for labor organizations, municipalities, and government entities.

Torelli holds an MBA from Mount Saint Mary College and a Bachelor of Science in Business Management and Marketing from Wilmington University .

At ProCare Rx, he will focus on strengthening partnerships and delivering transparent, cost-effective pharmacy benefit solutions that support unions, government groups, and their members nationwide.

ProCare Rx appoints JD Edwards as new Senior VP of Sales National Accounts

Wed, 27 Aug 2025 13:29:12 GMT

ProCare Rx Names JD Edwards Senior Vice President of Sales

Gainesville, GA — 8/27/2025, 2025 — ProCare Rx is pleased to announce that JD Edwards has joined the company as SVP of sales, national accounts. In this role, Edwards will oversee national sales account efforts, expand client partnerships, and support ProCare’s continued growth as one of the leading independent pharmacy benefit managers (PBMs) in the United States.

Edwards brings more than 20 years of experience in pharmacy benefit management and healthcare sales leadership. Most recently, he served as Vice President of Sales at Prime Therapeutics , where he managed a multistate sales and account management team. Prior to that, he was Director of Pharmacy Sales at Carelon Rx , leading a team of 27 professionals and driving significant growth across Medicaid, Medicare, and commercial markets.

Earlier in his career, Edwards held leadership positions at Magellan Rx Management and Remedy Analytics , where he focused on helping clients achieve cost savings and improved outcomes through innovative PBM strategies. He is also the founder of Pharmaceutical Insight Solutions , a consulting firm providing analytics, RFP support, and benefit management guidance.

At ProCare Rx, Edwards will focus on advancing national sales initiatives, developing client-centered solutions, and strengthening the organization’s position as a trusted PBM partner for employers, health plans, unions, and healthcare providers nationwide.

Welcome to the team, JD!

ProCare Rx Appoints Valerie Allen as Chief Financial Officer

Mon, 18 Aug 2025 13:49:26 GMT

This appointment brings together multiple parts of the business under one umbrella to best serve our PBM clients and members, assuring that ClearSight transparency and Lowest Net Cost remains at the forefront of the innovative organization.

Gainesville, GA, August 18, 2025 - ProCare Rx is proud to announce Valerie Allen has been named Chief Financial Officer. A seasoned financial executive with deep experience in audit, assurance, and financial strategy, Valerie steps into the newly carved out CFO role as the organization positions itself for its next phase of growth. The role was previously held by CEO Barbara Rambo and has now been separated to support continued scale and performance.

“We are proud to welcome Valerie to the ProCare Rx leadership team. “She brings a unique combination of technical expertise and leadership insight to our organization,” said Barbara Rambo, CEO of ProCare Rx. “Her background in audit and advisory services, combined with her work across diverse sectors of the insurance and healthcare industries, makes her exceptionally well-suited to support our continued growth and financial strength.”

Allen was previously at Windham Brannon, a recognized leader in providing assurance, tax and advisory services where she served as an Assurance Senior Manager. Prior to that she held customer support and management roles with Gallman Insurance, State Farm Insurance and Statewide Insurance.

“It’s an exciting time to join ProCare Rx,” said Valerie Allen. “This company has a strong reputation for innovation, integrity, and client service. I look forward to working alongside the leadership team to build on that legacy and contribute to our continued financial health and operational excellence.”

“As transparency and accountability continue to shape the future of pharmacy benefit management, we believe that same rigor should apply inside our own walls,” said Rambo. “Valerie’s expertise strengthens our ability to maintain the highest level of financial discipline, both in how we operate and in how we serve our clients. It’s about practicing what we preach.”

Valerie is a graduate of Georgia State University – J Mack Robinson School of Business where she received a Master of Professional Accountancy; and a Bachelor of Business Administration from Georgia Gwinnett College. She holds designations as both a Certified Public Accountant (CPA) and Certified Fraud Examiner (CFE). She resides in Monroe, Georgia and will work out of the Gainesville corporate headquarters.

What the Arkansas PBM Ruling Means for the Industry

Tue, 05 Aug 2025 13:21:12 GMT

When Courts and Care Collide: What the Arkansas PBM Ruling Means for the Industry

A recent court decision in Arkansas has once again put pharmacy benefit managers (PBMs) under the spotlight. A federal judge ruled to block an Arkansas law that would have prevented PBMs from owning pharmacies. The reason? The judge said the law likely conflicts with federal rules.

To understand why this matters, it helps to take a step back.

PBMs help employers and health plans manage prescription drug benefits. That includes negotiating drug prices, building pharmacy networks, and setting reimbursement rates. In some cases, PBMs also own their own pharmacies, something critics say creates a conflict of interest.

Arkansas lawmakers tried to stop that by passing a law in 2023 that banned PBMs from owning pharmacies or making pharmacy referrals. Several PBMs pushed back, and the case ended up in court. In July 2025, a federal judge sided with the PBMs, saying the state law could not override federal regulations under Medicare Part D.

But that was not the only PBM headline in Arkansas. Just days before, state officials filed a major lawsuit against several of the largest PBMs, claiming they drove up costs and hurt local pharmacies by setting unfair reimbursement rates.

So, what does this mean for the rest of us?

It is a reminder that the pharmacy benefits world is changing fast. Employers and plan sponsors need PBM partners who do more than just follow the rules. They need partners who lead with transparency.

At ProCare Rx, transparency is not just a feature. It is a foundation. We give plan sponsors full visibility into pricing, contracts, and claims. That means no hidden fees. No backdoor deals. And no confusion about where your dollars go.

In moments like these, when laws are challenged and lawsuits are filed, clarity matters more than ever. When employers and health plans know exactly how their pharmacy dollars are being spent, they can make better decisions for their members.

Regulations may change. But our commitment to clear, ethical, and compliant service never will.

Prescription Drug Pricing: Will Policy Fix What Patients Feel?

Tue, 08 Jul 2025 18:51:40 GMT

Prescription Drug Pricing: Will Policy Fix What Patients Feel?

The cost of prescription drugs in America continues to dominate headlines, and for good reason.

Recently, the White House announced plans to implement Most-Favored-Nation (MFN) pricing for prescription drugs. The goal is to ensure Americans pay no more than patients in other economically comparable countries for the same medications.

What is MFN Pricing?

MFN pricing ties the cost of drugs in the U.S. to the lowest price paid by other developed nations. It is an attempt to tackle the reality that Americans often pay two to four times more for brand-name medications compared to patients in Canada, the UK, or Australia.

The new executive order directs the Department of Health and Human Services to implement rules requiring drug manufacturers to align U.S. prices with the lowest available price among OECD nations. This could create significant shifts in how medications are priced and accessed domestically.

Will Policy Alone Solve High Costs?

While MFN pricing has the potential to lower costs for Medicare and some commercial plans, policy implementation can take time and may face legal or industry challenges.

In the meantime, employers and plan sponsors continue searching for practical ways to help patients afford medications today without waiting for legislative change.

International Sourcing as an Interim Solution

One approach already in place is international prescription sourcing through programs like ProCare Rx’s SavingEDGE Smart Delivery – International (SDI).

Here is what these programs do:

Source maintenance medications from Tier 1 countries such as Canada, the UK, Australia, and New Zealand
Offer FDA-approved brand medications at a fraction of U.S. costs
Maintain safety standards and bioequivalence requirements
Deliver medications directly to members’ homes with zero out-of-pocket costs

These programs help plan sponsors reduce spend while keeping patients on their necessary therapies, addressing the affordability challenge without waiting on policy reform.

Looking Ahead

The MFN executive order represents a major shift in U.S. drug pricing policy, aiming to bring prices in line with global standards. But even if fully enacted, these changes will take time.

In the meantime, solutions like international sourcing programs remain a practical bridge, ensuring patients can access life-sustaining medications safely and affordably.

Want to learn more about international prescription sourcing?
Visit rxhelp.procarerx.com or call (855) 828-1484 to explore how it can integrate with your benefits strategy.

How to Spot Red Flags in Pharmacy Benefit Management

Mon, 02 Jun 2025 13:41:35 GMT

Is Your PBM Working for You…Or Against You? How to Ask the Right Questions and Spot Red Flags in Pharmacy Benefit Management

Pharmacy benefits shouldn’t feel like a guessing game. But for many plan sponsors, that’s exactly what it becomes. Hidden fees, unclear pricing structures, and limited access to data can make it tough to tell whether your PBM is truly aligned with your goals - or quietly profiting at your expense.

At ProCare Rx, we believe the best way to fix that is simple: transparency. When you know what questions to ask, you can start to see who’s really working in your best interest.

Start with the Basics
If you’re unsure whether your PBM is helping or hurting your plan performance, ask these straightforward questions:

Do you adjudicate claims in-house?
Do you own your own mail order pharmacy?
Do you take spread on generic drugs?

If the answers aren’t clear - or worse, avoided - you’ve got your answer. Lack of clarity usually means there’s something to hide.

Yes, Transparent Pricing Exists
It’s a myth that opaque pricing is just “how the industry works.” True transparency is not only possible, it is being done. ProCare Rx is among the few PBMs offering fully pass-through pricing. That means you see exactly what a drug costs, where every rebate goes, and how your pharmacy dollars are being spent. No games. No hidden margins. Just clean, accountable pricing.

Smart Questions to Include in Your Next RFP
Want to separate the transparent PBMs from the rest? Try adding these questions to your next pharmacy request for proposal:

How do you make money?
Will you share 100% of rebates?
Do I have full access to and ownership of my data?
Can you support specialized needs like 340B or international sourcing?

These questions uncover financial motivations, data accessibility, and service capabilities - all critical for making a sound, strategic PBM decision.

Clarity Is Possible
Pharmacy benefits don’t have to be confusing. When you ask the right questions, you find the right partners. And when you work with a PBM built on transparency, flexibility, and client control, you unlock savings and performance that are sustainable.

If you're ready to expect more from your PBM, ProCare Rx is ready to deliver.

ProCare Rx Announces New Executive Appointment and Launch of Technology Division

Tue, 20 May 2025 15:10:35 GMT

ProCare Rx Announces New Executive Appointment and Launch of Technology Division to Drive Innovation and Growth

The newly created role is expected to solidify leadership of the core technology

infrastructure to both enhance support for current clients as well as developing

additional value-added offerings to the marketplace.

Gainesville, GA, - May 19, 2025 - ProCare Rx, a trusted leader in the Pharmacy Benefit Management (PBM) and Claims Processing space, with 38 years of service excellence, is proud to announce that Sathya Srinivasan, an experienced industry visionary, has been named President of its newly established Technology division. This strategic role was created to complement the established PBM business as part of a broader organizational realignment aimed at optimizing the firm’s core technology infrastructure while accelerating the development of innovative, value-added products and services. The move underscores ProCare Rx’s continued commitment to staying at the forefront of technological advancement and delivering exceptional value to its clients.

“We are proud to welcome Sathya to the ProCare Rx leadership team,” said Barbara Rambo, CEO/CFO of ProCare Rx. “He brings deep experience in the Pharmacy Benefits Management (PBM) and Payor Solutions & Services space, with a 20-year, proven track record of building and maintaining long-term, consultative senior executive customer relationships, serving as a trusted business advisor, and delivering thought leadership and innovation. Sathya’s leadership will be instrumental as we continue to fully leverage ProCare Rx’s claims processing and related technology infrastructure to deliver leading edge and technology-based products to serve both internal and external customers.”

Srinivasan was previously at e-Zest Solutions as the Senior Vice President and Healthcare Practice Lead, and prior to that he held various executive roles in operations, delivery, client services, and reporting/analytics with CVS Health, IBM, and GalaxE.Solutions. His responsibilities included sales, strategy, account management, implementation, client delivery and customer satisfaction.

“I’m honored to join ProCare Rx at such a transformative time in the PBM industry,” said Sathya Srinivasan, President of ProCare Rx’s Technology business. “With over 20 years of experience in healthcare technology and services, I’m focused on advancing solutions that improve outcomes, drive efficiency, and support brokers, third-party administrators, employers and patients alike. My goal is to lead with purpose and integrity, aligning with ProCare Rx’s mission to deliver innovative, cost-effective solutions that elevate the quality of care and client satisfaction.”

“Sathya’s deep expertise and passion for service, innovation, and operational excellence will be instrumental as we accelerate our growth and expand technology-driven value to clients,” said Ms. Rambo. “His leadership will strengthen the organization’s technical capabilities, drive solution development, and sharpen the competitive edge in the market.”

Sathya is a graduate of the University of Madras – India where he earned a Bachelor of Engineering degree in Computer Science. While he anticipates continuing to leverage his home base in Dallas, TX where he resides with his family, he will dedicate considerable time with the key ProCare Rx team members, clients, and prospects across multiple locations.

Understanding the “Most Favored Nation” Drug Pricing Rule

Mon, 19 May 2025 16:20:48 GMT

Understanding the “Most Favored Nation” Drug Pricing Rule

A new executive order from former President Trump is once again putting the spotlight on drug pricing in the U.S. The order calls for the U.S. to adopt a “most favored nation” (MFN) policy on prescription drugs—a move that ties what Medicare pays for certain drugs to the lowest price paid by other developed countries.

This idea isn’t brand new. It was first introduced during Trump’s time in office and has now been reissued. The goal is clear: to lower out-of-pocket drug costs for Americans by linking U.S. drug prices to those in other countries.

But what does this mean for patients, providers, and the pharmacy benefit industry?

Let’s break it down—starting with the basics.

What Is the “Most Favored Nation” Rule?

Under this order, Medicare would not pay more for select prescription drugs than the lowest price paid in other comparable countries. This approach aims to prevent Americans from paying more than people in places like Canada, France, or the U.K. for the same medication.

The rule would start with certain high-cost drugs, especially those administered in a doctor’s office or hospital (like infusions or specialty medications), with room to expand over time.

Potential Pros:

Lower Prices for Patients
Tying prices to international benchmarks could lead to significant savings for Medicare and for seniors who rely on these drugs.

Pressure on Drug Manufacturers
It may push pharmaceutical companies to rethink how they price drugs in the U.S., helping to bring down costs long-term.

Cost Transparency
The approach could make it easier for the public to see how U.S. prices stack up globally, driving more informed conversations about drug pricing reform.

Potential Cons:

Access Risks
Some worry that drug manufacturers might limit the supply of certain medications to avoid the lower reimbursement rates, which could create access issues.

Innovation Concerns
There’s debate over whether international reference pricing could reduce the funds available for future drug research and development.

Implementation Complexity
Tying U.S. payments to prices in other countries sounds simple—but the reality of setting, tracking, and updating those prices is anything but.

The ProCare Rx Perspective: Guided by Our Standards

At ProCare Rx, our approach to drug pricing and benefit management is grounded in our 7 PBM Standards. These principles reflect our commitment to clarity, accountability, and value for our clients and their members:

1. Direct-Source PBM
We own our claims processing system, pharmacy network, and rebate contracts—ensuring full control and alignment with client goals.

2. Lowest Net Cost Philosophy
We always prioritize efficacy and patient care while driving the lowest total cost for plans.

3. Pass-Through Pricing
There are no drug mark-ups or hidden spreads. Our evergreen contracts guarantee pass-through and lowest price models with audit rights built in.

4. Access to Data
Clients can take control by reviewing invoices with claim-level detail—true visibility into what’s being paid and why.

5. Data Driven Technology & Functionality
Our technology enables complex benefit design changes in minutes and supports real-time issue resolution at the pharmacy counter.

6. Honesty
We provide same-day, same-drug claim analysis, ensuring decisions are based on facts, not assumptions.

7. Integrity
Everything we do is built for auditability and tangible proof—supporting our transparent pass-through pricing commitments.

Final Thoughts

The “most favored nation” policy has potential to shake up how drug pricing works in this country. Whether that change is for better or worse will depend on how it's implemented—and whether all stakeholders, including patients, providers, and payers, have a voice in the process.

As always, ProCare Rx remains committed to advocating for smart, patient-focused solutions. We’ll keep watching this issue closely—and continue to stand by our mission of delivering better outcomes, lower costs, and exceptional service every step of the way.

The Importance of Transparency: ProCare Rx's EDGE Program

Mon, 19 May 2025 12:38:26 GMT

ProCare Rx's Innovative Approach to Pharmacy Benefit Management

Pharmacy benefit managers (PBMs) are often under scrutiny due to rising pharmacy costs and a perceived lack of transparency for plan sponsors. In a recent podcast appearance, Marc Cohen, Vice President of Sales and Marketing at ProCare Rx, shared how our company is leading the way in redefining what plan sponsors can expect from a PBM.

During the conversation, Marc highlights ProCare Rx’s commitment to clear-sight transparency , cost containment, and clinically sound programs that deliver real value. He also discusses the power of our EDGE program , designed to give plan sponsors more insight, more control, and better outcomes.

Listen to the episode to learn how ProCare Rx is driving innovation and accountability in the PBM space.

ProCare Rx Appoints John Drakulich as President of their PBM Business

Tue, 06 May 2025 19:16:29 GMT

ProCare Rx Appoints John Drakulich as President of their PBM Business

This appointment brings together multiple parts of the business under one umbrella to best serve our PBM clients and members, assuring that ClearSight transparency and Lowest Net Cost remains at the forefront of the innovative organization.

Gainesville, GA, May 5, 2025 - ProCare Rx is proud to announce John Drakulich has been named President of their PBM business group. An experienced industry leader, John will assume responsibilities on May 19th. This role was created as the 38-year-old firm re-organizes to best serve their clients.

“We are proud to welcome John to the ProCare Rx leadership team,” said Barbara Rambo, CEO/CFO of ProCare Rx. “He is a respected and visionary leader in the PBM industry, with a demonstrated ability to drive growth and innovation. His breadth of experience across key markets—commercial employers, payers, government, hospitals, health systems, labor groups and other carve out programs—aligns perfectly with our strategic direction. John's leadership will be instrumental as we continue to deliver value and advance our mission.”

Drakulich was previously at RxSense as the Senior Vice President of Health Plan Sales, and prior to that he held various executive roles in Sales and Operations with OptumRx, Prime Therapeutics, Anthem, PCS Advance, and ValueRx. His responsibilities included sales strategy, operational transparency, PBM sales, value proposition, and leveraging cross functional leadership across organization to gain buy-in and support for highly profitable production. His efforts have delivered substantial increases in new revenue, and lives.

“I’m honored to join ProCare Rx at such a pivotal time in its journey,” said John Drakulich President of ProCare Rx’s PBM line of business. “The company has a strong foundation and a clear vision; one we will build upon by rendering innovative strategies and products that enhance our differentiation and deepen the value we deliver to clients. With over 3 decades in the PBM space, I understand the complexity and opportunity in this industry, and I am excited to lead a team so deeply committed to redefining what pharmacy benefit management can achieve.”

“John brings a long and diverse history of innovation that has consistently driven strategic differentiation and sharpened organizational focus,” said Barbara Rambo, CEO/CFO of ProCare Rx. “With decades of experience in the PBM industry, he has a deep understanding of pharmacy financials and the underwriting of pharmacy products and services. His insight and leadership will play a critical role in strengthening our market position and refining our value proposition as we enter our next phase of growth.”

John is a graduate of the University of Colorado – Denver where he earned a BS in Business, Management, Marketing, and Related Support Services. While he anticipates continuing to leverage his home base in Minneapolis, MN where he resides with his family, he will dedicate considerable time with the key ProCare Rx team members, clients, and prospects across multiple locations

ProCare Rx’s ProCare PharmacyCare, LLC Earns URAC Accreditation in Specialty Pharmacy

Mon, 21 Apr 2025 16:11:40 GMT

ProCare Rx’s ProCare PharmacyCare, LLC Earns URAC Accreditation in Specialty Pharmacy

• URAC accreditation reflects ProCare Rx’s commitment to achieving and maintaining the highest quality, member engagement and experience, and operational standards for Specialty Pharmacy in the industry. The designation demonstrates a meaningful commitment to quality health care.

Gainesville, GA, April 21, 2025 - ProCare Rx is proud to announce that its affiliated pharmacy, ProCare Rx PharmacyCare LLC, has earned URAC accreditation for Specialty Pharmacy. URAC is the independent leader in promoting health care quality by setting high standards for clinical practice, consumer protections, performance measurement, operations infrastructure, and risk management. By achieving this status, ProCare Rx’s affiliated pharmacy has demonstrated its commitment to quality care, enhanced processes, patient safety, and improved outcomes. The Specialty Pharmacy Accreditation is in addition to earning accreditation from URAC for Mail Service Pharmacy. ProCare Rx has additionally maintained URAC accreditation for Pharmacy Benefit Management since 2015. ProCare Rx further follows the NIST SP 800-53 Cybersecurity and HITRUST standards, and is has maintained processing control environments to meet AICPA SOC 1 Type 2 and SOC 2 Type 2 + HIPAA requirements.

“Gaining URAC Specialty Pharmacy accreditation is a tremendous accomplishment and demonstrates ProCare Rx’s overall commitment to excellence and adherence to standards in the Specialty Pharmacy arena,” said Susan Castillo, VP, Pharmacy Operations – ProCare Rx. “2025 marks the first time our ProCare Rx PharmacyCare group has been recognized with the URAC Specialty Pharmacy Accreditation. I am so incredibly proud of our team of dedicated professionals who consistently demonstrate the highest level of commitment and quality of service to our industry, clients, employees, and the lives we cover,” added ProCare Rx Chief Executive Officer Barbara Rambo.

ProCare Rx PharmacyCare offers specialty pharmacy programs that demonstrate excellence and adherence to highest standards with staff having the necessary training, expertise, and competency for patient care services and clinical case management. This accreditation reinforces that ProCare Rx meets all payer requirements for financial reimbursement; provides access to networks; streamlines processes and improves efficiency, leading to better patient care and outcomes, and reduces the burden of oversight ensuring a consistent level of assurance that the quality of service meets all recognized standards. URAC Specialty Pharmacy Accreditation is the standard relating to clinical management, and our attainment demonstrates that our clinical intake meets or exceeds expectations

“Now more than ever, specialty pharmacies are an essential part of the patient care team and patient experience. URAC congratulates ProCare Rx’s ProCare PharmacyCare on their achievement of Specialty Pharmacy Accreditation. This achievement demonstrates excellence in pharmacy operations, product handling, patient education, and patient management. When

an organization achieves URAC accreditation, they demonstrate their commitment to improving their quality of care, which is important to patients, providers and payers,” said URAC’s President and CEO Shawn Griffin, MD.

To learn more about ProCare Rx, please visit http://www.procarerx.com

To view our certification: https://accreditnet.urac.org/directory/#/accreditation/SPP010404/info

About URAC

Founded in 1990 as a non-profit organization, URAC is the independent leader in promoting health care quality and patient safety through renowned accreditation programs. URAC develops its evidence-based standards in collaboration with a wide array of stakeholders and industry experts. The company’s portfolio of accreditation and certification programs spans the health care industry, addressing health equity, workplace mental health, health care management and operations, pharmacies, telehealth, health plans, medical practices and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.

To learn more about URAC’s stringent standards and evaluation process for Specialty Pharmacy, please visit https://www.urac.org/accreditation-cert/specialty-pharmacy/

Prescription Drug Reform Gains Momentum: What the New Senate Bill Means for Plan Sponsors

Tue, 15 Apr 2025 14:38:32 GMT

Prescription Drug Reform Gains Momentum: What the New Senate Bill Means for Plan Sponsors

The Senate Judiciary Committee has unanimously advanced the Prescription Pricing for the People Act of 2025 . The voice vote signals rare bipartisan agreement on a complex issue: prescription drug pricing and the role of pharmacy benefit managers (PBMs) in driving those costs.

The legislation, if passed, would require the Federal Trade Commission (FTC) to further investigate the practices of intermediaries in the pharmaceutical supply chain—and recommend policies that promote transparency and fair competition. It’s a move that reflects growing concern about market consolidation, limited pricing visibility, and the potential impact on patients and payers alike.

It’s also a step toward giving plan sponsors the information they need to make better decisions. And that’s something we believe in deeply.

What’s in the Prescription Pricing for the People Act of 2025?

The bill, introduced by Senator Chuck Grassley (R-IA), directs the FTC to examine how PBMs influence drug pricing, reimbursement, and patient access. Specifically, it calls for a study of:

PBM pricing and spread practices
Investigating whether PBMs are reimbursing pharmacies less than they charge plan sponsors.
Patient steering to owned pharmacies
Determining whether PBMs direct patients toward affiliated pharmacies, limiting choice and impacting independents.
Use of competitive pharmacy data
Exploring how PBMs may use claims data from unaffiliated pharmacies to gain a market edge.
Formulary design and cost structure
Looking at whether PBMs design formularies in ways that favor higher-cost drugs when lower-cost options are available.

The FTC would be required to submit an interim report within 180 days of enactment and a final report within one year—both with recommendations for legislative or regulatory action.

Why It Matters

This legislation comes amid broader concerns over how opaque pricing and consolidation in the pharmacy supply chain affect employers, health plans, and patients. As Congress takes a closer look, plan sponsors are being asked to do the same—evaluating whether their PBM relationships are really delivering on value, access, and cost control.

The push for oversight is less about political positioning and more about rebalancing the system. Right now, too many decision-making levers are hidden from the people actually footing the bill.

Supporting Plan Sponsor Control

While transparency is essential, it’s only part of the equation. At ProCare Rx, we believe that plan sponsors deserve more than visibility—they deserve control.

That means:

Contracts with clear terms and no surprise fees
Access to real-time data for smarter, faster decisions
The ability to customize benefit design, rather than accept a one-size-fits-all model
A pharmacy benefit partner that answers to you , not to shareholders or owned pharmacies

This is one of our Seven Pillars for a reason: when employers have more control, they can manage their risk more effectively, protect their members more thoughtfully, and ensure that pharmacy benefits remain sustainable long-term.

Looking Ahead

As the Prescription Pricing for the People Act of 2025 continues to move forward, we see an opportunity to bring greater balance to the pharmacy benefit landscape—one where decisions are driven by value, not volume.

For plan sponsors and the patients they serve, that’s a win.

We’ll continue to follow this legislation closely and share updates as they become available.

The Make America Healthy Again Commission: What It Means for Pharmacy Benefits

Wed, 02 Apr 2025 13:21:00 GMT

The White House recently launched the Make America Healthy Again Commission to

address some of the biggest challenges in U.S. healthcare—including chronic disease,

medication reliance, and drug safety. While the full impact remains to be seen, this

initiative signals potential shifts in how prescription drugs are evaluated, priced, and

prescribed.

For plan sponsors, employers, and pharmacy benefits managers (PBMs), the key

question is: How can we ensure medication access, affordability, and safety while

staying ahead of possible regulatory changes?

Reevaluating Medication Reliance

One of the Commission’s focus areas is over-reliance on medication and treatments.

This could lead to a push for more careful prescribing practices, increased scrutiny

of high-cost drugs, and expanded support for alternative treatment methods.

PBMs can play a proactive role by ensuring plan designs promote clinically effective,

cost-conscious prescribing, including:

Encouraging use of generics and biosimilars when available
Implementing clinical programs that support appropriate prescribing
Providing medication management resources to help members navigate treatment options

Increased Attention on Drug Safety & Pricing

The Commission also highlights food and drug quality and safety , reinforcing the

need for greater transparency in pharmaceutical manufacturing and pricing . This

could mean:

Tighter regulations on imported medications and supply chain oversight
More scrutiny on rebate structures and how drug prices are set
A renewed focus on affordability strategies for plan sponsors and consumers

For PBMs and health plans, transparent pricing models and clear rebate structures

will be key to staying compliant and ensuring members have access to safe, fairly

priced medications.

Eliminating Conflicts of Interest in Health Research

Another priority for the Commission is ensuring federally funded health research is

free from conflicts of interest . This could impact how drug effectiveness is studied,

how formularies are built, and how treatment guidelines are developed.

Employers and health plans should work with PBMs that prioritize:

Data-driven formulary management based on independent clinical outcomes
Objective drug evaluations to balance cost and effectiveness
Transparent partnerships with health providers and pharmaceutical companies

What’s Next?

The Make America Healthy Again Commission is still in its early stages, but its focus on

medication reliance, drug safety, and pharmaceutical pricing should not be ignored.

Employers and plan sponsors should be prepared for potential policy changes

that could impact pharmacy benefits.

By working with PBMs that prioritize clinical integrity, cost control, and member

education , organizations can stay ahead of the curve and continue to provide high-

quality, affordable healthcare solutions.

Would you like to review your pharmacy benefits strategy? Let’s talk. Click the button below to learn more about ProCare Rx's Offering and signup to hear from one of our sales team.

FTC Case Study

Mon, 03 Mar 2025 19:46:31 GMT

FTC Report Reveals $7.3 Billion in Excessive PBM Revenues—What It Means for Employers and Patients

On January 14, 2025, the Federal Trade Commission (FTC) released its second interim report, revealing that the three largest pharmacy benefit managers —CVS Caremark, Cigna's Express Scripts, and UnitedHealth's Optum Rx—generated over $7.3 billion in excessive revenues from 2017 to 2022 by marking up specialty generic drug prices. These price increases affected critical medications used to treat conditions such as HIV and cancer, with the PBMs inflating drug prices at their affiliated pharmacies by significant percentages, thereby increasing costs for patients, employers, and health plans.

Understanding the FTC's Findings

The FTC's report highlights the significant influence PBMs have over drug pricing and access. The findings suggest that the business practices of these major PBMs can lead to increased costs for essential medications, impacting patients and the broader healthcare system. As FTC Chair Lina M. Khan stated, "The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs—including overcharging patients for cancer drugs."

Advocating for Ethical PBM Practices

We believe that PBMs should prioritize the well-being of patients by ensuring access to affordable medications. Our approach focuses on providing clients with transparent, customizable solutions that align with their specific needs, without unnecessary markups or hidden costs.

Looking Ahead

In light of the FTC's findings, it's crucial for stakeholders in the healthcare industry to advocate for practices that promote fairness and affordability. By choosing partners who prioritize transparency and patient care, we can work together to create a more equitable healthcare system.

ProCare Rx remains dedicated to being a trusted partner in managing pharmacy benefits, offering solutions that are both innovative and aligned with the best interests of our clients and their members.

Choosing a PBM That Works for You

Employers and health plans need to ask themselves an important question: Is my PBM working for me, or against me? The FTC’s findings highlight how some PBMs prioritize profits over patient care , but it doesn’t have to be this way. At ProCare Rx , we believe in fair, transparent pricing and accountability , ensuring that our clients get the best value without hidden costs. As a trusted PBM partner since 1987 , we remain committed to helping employers and health plans navigate an increasingly complex system—with honesty, transparency, and a focus on real savings.

To learn more about how ProCare Rx operates differently , check out our Seven PBM Standards one-pager: Download Here

By demanding integrity and transparency , employers can take control of their pharmacy benefits and ensure their members receive affordable, high-quality care.

GLP1s – Through the Looking Glass

Mon, 20 Jan 2025 22:15:05 GMT

Where We Were and Where We Are Headed

GLP-1 usage increased dramatically in 2024, due in part to its dual role in managing diabetes and producing weight loss. The growing popularity of the GLP-1s provides an indication of the medication’s effectiveness, however, it is less certain how employers view the GLP-1s in terms of providing benefit coverage for these types of medicines. To gain additional insight on how self-funded employers are viewing GLP-1s, we took a look at claims from ProCare Rx self-funded employer clients who had at least 1 member attempting to fill the medication this past year. Here is what we found:

Throughout 2024, coverage for the GLP1s medications formulated for the treatment of Diabetes was widespread among self-funded employer groups. We found that only 1 in 10 Groups rejected any claim for medicines in this therapeutic class for the reason “drug not covered”. However, this did not mean the percentage of Groups generating a paid claim was 90%. Through the clinical protocols, step therapies and prior authorization requirements put in place on behalf of the plan sponsor and, in some cases then overwritten by the Plan Sponsor, only 6 out of 10 Groups had a paid claim for a GLP1s in this therapeutic category. However, the tide appears to be turning. In the past 3 months, the number of Groups generating a paid claim for Diabetes formulated GLP1s increased to 8 out of 10 Groups. This indicates that coverage restrictions are decreasing and/or plan sponsor overrides are increasing. Overall, the number of paid claims for GLP-1s formulated to treat Diabetes increased by 25% from Q1 2024 to Q4 2024.

Unlike the GLP1s formulated for Diabetes, GLP1s medications formulated for Weight Management continued to have limited benefit coverage among self-funded employer groups. 7 out of 10 Groups rejected any claims for medicines in this therapeutic class for the reason “drug not covered.” In addition, clinical protocols, step therapies and prior authorization requirements administered by us and not overridden by the plan sponsor, lowered the number of Groups with a paid claim 2 out of 10. While the number of Groups paying claims for Weight Management GLP1 claims held steady, the volume of claims nearly doubled, increasing by 86% from Q1 2024 to Q4 2024.

As we move forward, your organization needs to be prepared for the GLP-1 storm that continues to build momentum, making “Not Covered/No-Coverage” line, harder and harder to maintain. And, for those Groups that did open up and started to allow coverage for these types of GLPs, you will want to make sure programs are in place to manage the volume growth and help ensure proper utilization.

This IS happening. Are YOU prepared? Don’t navigate the GLP-1 waters alone. As a trusted partner, ProCare Rx can help you navigate this storm and protect your organization.

To learn more about ProCare Rx’s suite of pharmacy benefit solutions, please visit www.procarerx.com

ProCare Rx Earns Full URAC Reaccreditation in Pharmacy Benefit Management

Thu, 12 Dec 2024 18:34:57 GMT

URAC accreditation reflects ProCare Rx’s commitment to achieving and maintaining the highest quality, member engagement and experience, and operational standards for PBMs in the industry

Gainesville, GA, December 12, 2024 - ProCare Rx, a leading provider of pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) solutions that reduce plan sponsor and employee pharmacy costs and improve clinical outcomes, has received full URAC reaccreditation for our Pharmacy Benefit Management Services supporting our affiliated PBM offerings as well as those of their clients. The organization and its affiliates have been URAC accredited since 2010. In addition to earning. In addition to earning accreditations or certifications from URAC for PBM and Mail Order Pharmacy, and HITRUST, ProCare Rx holds NIST SP 800-53 cybersecurity standard, and AICPA SOC 1 Type 2 and SOC 2 Type 2 + HIPAA certifications.

“Gaining URAC Pharmacy Benefit Management accreditation is a tremendous accomplishment and is reflective of the efforts of the many dedicated professionals involved in the process at ProCare Rx,” said Marileny Lugo, President MC-Rx. ProCare Rx Chief Executive Officer Barbara Rambo added, “2025 marks the 10th year under the ProCare Rx name in the US and the 15th year under the MC-Rx/MC21 name in Puerto Rico, that our overall solution has been accredited. I am incredibly proud of everyone throughout the organization who has contributed to bringing the highest level of commitment to our industry, clients, employees, and the lives we cover, delivering clinical-based outcomes.“

ProCare Rx offers programs that bring the appropriate balance of cost management and plan management to your organization, and illuminates the way to savings for everyone. At a time when satisfaction with traditional PBMs is at the lowest level in a decade, ProCare Rx will continue to raise the bar with ClearSight Transparency – a clear, direct look into your data, pricing, and claims cost. Built upon a foundation that has supported pass-through pharmacy benefit model since the beginning, the ProCare Rx organization helps to ensure that a maximum network cost savings and, other benefits are available to its plan sponsor clients. The URAC Pharmacy Benefit Management seal shows an organization’s commitment to high quality in healthcare in the areas of risk management, consumer protection and empowerment, operations and infrastructure, as well as performance management and improvement. We are proud to recognize ProCare Rx / MC-Rx for their achievement in these areas,” said URAC President and CEO, Shawn Griffin, MD.

To learn more about ProCare Rx’s suite of pharmacy benefit solutions, please visit www.procarerx.com .

About URAC

To learn more about URAC’s stringent standards and evaluation process for PBMs, please visit

https://www.urac.org/accreditation-cert/pharmacy-benefit-management-accreditation/

ProCare Rx Receives Full Certification from the Centers for Medicare and Medicaid Under 2025 Prescription Drug Event (PDE) Data Submission Guidelines

Tue, 26 Nov 2024 04:49:42 GMT

ProCare Rx, a leading pharmacy claims processor, has received updated certification from the Centers for Medicare and Medicaid (CMS) 2025 Prescription Drug Event (PDE) data submissions beginning January 1, 2025. Our certification covers both the Traditional Medicare and Medicaid Plans as well as the Program of All-Inclusive Care for the Elderly (PACE) Medicare Part D. As one of the first dual-compliant providers, our customer regulatory reporting will continue to meet both current and new 2025 submission requirements.

This program-wide recertification was mandated by CMS, and included significant changes in the PDE File Layout expansion and introduction of new financial and non-financial data fields on the PDE record.

Some of the changes applicable to all Part D sponsors include:

“ Vaccine Administration Fee or Additional Dispensing Fee ” (This removed reference to Emergency Use Authorization (EUA) status of oral antiviral drugs)
“ Drug Status Indicator, ” determines that the National Drug Code (NDC) submitted on the PDE was an applicable drug or non-applicable drug at the time of PDE processing.

For PACE claims there are a variety of additional financial/non-financial fields and indicators that must be included in a claim:

Estimated Remuneration at POS Amount (ERPOSA)
Pharmacy Price Concessions at POS
Patient Pay Amount
Patient Liability Reduction Due to Other Payer Amount (PLRO)
Other TrOOP Amount/Indicator
Selected Drug Subsidy
Reported Manufacturer Discount
Gross Drug Cost Below Out-of-pocket Threshold (GDCB)
Gross Drug Cost Above Out-of-pocket Threshold (GDCA)
Low Income Cost Sharing Subsidy Amount (LICS)
Non-covered Plan Paid Amount (NPP)
Originally Prescribed Quantity
Part D Model Indicator
Medicare Prescription Payment Plan Indicator

Kristi Mitchell, ProCare Rx Vice President of Product Management and Implementation stated, “This certification is a testament to our team’s hard work and dedication. The journey to ensuring that we are able to meet the new CMS reporting requirements on behalf of our clients has been incredibly rewarding, and we express our sincere gratitude to all our clients, employees, and everyone in the ProCare Rx family for their continued support. We look forward to achieving many more milestones together in the future!”

The 2025 PDE Testing and Certification Protocol for non-PACE Part D sponsors is posted at www.csscoperations.com

FTC Hearing Recap

Thu, 08 Aug 2024 16:32:45 GMT

A Pivotal Moment for PBM Accountability

The FTC hearing held on July 23rd has marked a significant milestone toward greater accountability and transparency in the PBM industry. Top executives from CVS Caremark, Optum Rx, and Express Scripts were present, collectively controlling approximately 80% of the US prescription market. The hearing highlighted the critical need for stringent reporting requirements, restrictions on PBM-owned pharmacies, and measures to prevent anti-competitive practices. This is a momentous development for taxpayers and patients who could benefit from lower drug costs and improved access to medications.

The ongoing investigation into the PBM industry's practices underscores the importance of fair business practices, and ProCare Rx is at the forefront of advocating for these changes.

Overview of the FTC Hearing

The FTC hearing focused on addressing the concentration of power among the major PBMs and their influence on drug prices. The key points discussed included the imbalance of power, consolidation of the market, and the impact on smaller pharmacies and consumers. The FTC expressed concerns over the lack of transparency in how PBMs negotiate rebates and discounts, often limiting access to cheaper generic alternatives. The hearing underscored the need for regulations to ensure fair competition and to protect consumer interests. As Chairman James Comer (R-KY) states:

“Since 2021, the Committee has made it a priority to expose harmful PBM practices and advance legislative solutions to ensure greater transparency and accountability in the PBM industry. Instead of prioritizing the health of Americans across the country, evidence obtained by the House Oversight Committee shows how the three largest pharmacy benefit managers colluded to line their own pockets.”

Impact on the PBM Industry

The hearing's outcome could lead to significant changes in the PBM landscape. Potential regulations could enforce transparency and accountability, requiring PBMs to report their practices more openly. This would benefit taxpayers and patients by potentially lowering drug costs and improving access to necessary medications. The industry may see a shift toward more ethical practices, aligning with ProCare Rx's long-standing commitment to transparency.

ProCare Rx's Position and Commitment

ProCare Rx has always operated with a focus on transparency and pass-through pricing, managing care and costs with the patient and sponsor at the center. Our Chief Growth Officer, Doyle Jensen, emphasizes that ProCare Rx has consistently prioritized fair business practices. "Over 30 years ago when ProCare Rx was founded, it was 'transparent and pass-through'. This is one of the most exciting times for the PBM industry. The exposure that is unfolding shows that the main players are not focused on managing a prescription benefit for the patient or the sponsor, but for their profitability. We at ProCare Rx will always focus on managing care and cost with the patient and sponsor at the nexus."

ProCare Rx also takes security and system uptime seriously, with no breaches or downtimes, setting a high standard in the industry. Our business model is built on principles that differentiate it from major PBMs:

Lowest Net Cost with High Efficacy : We save our clients millions of dollars annually by focusing on the lowest net cost formulary.
Transaction-Based Compensation : We offer transparent and fair pricing models, ensuring clients pay exactly what the pharmacy charges without hidden spreads.
No Ownership of Pharmacies : Our independence ensures that we do not mandate high-cost prescriptions through our mail order, leading to significant savings.
Cost Savings Programs : We consistently achieve optimal outcomes for our clients through innovative cost-saving programs.
Direct Source Technology : Our direct-source system allows us to account for every dollar of drug spend -- something most other PBMs can’t claim. We control our entire process, allowing us to oversee every step and provide you with accurate data and representation.

The FTC hearing represents a positive step toward reforming the PBM industry. At ProCare Rx, we are optimistic about the future and remain committed to leading the industry with transparency, fairness, and a patient-centric approach. We invite clients and stakeholders to engage with us to discuss the potential changes in the PBM industry and how ProCare Rx can help navigate these changes and optimize their benefits. Together, we can achieve a more accountable and efficient PBM landscape.

Setting Your Rx Coordinates: Navigating the Evolving Rx Landscape in 2024

Thu, 07 Mar 2024 21:36:43 GMT

With the new year comes new Rx updates to plan for and keep an eye on.

At ProCare Rx, we’ve got our eyes constantly on the horizon, watching for any movement in the industry that could affect you. Two specific areas include specialty drugs and biosimilars. Research shows that prescription costs are projected to rise nearly 10% this year alone. Specialty drugs, on the other hand, are predicted to rise by 15%, growing at a faster and more concerning rate. 1 With the similarly growing demand for specialty drugs, it’s a good time for employers to start planning for how they will cover these medications.

Here are a few things to keep in mind about the drug landscape and specialty Rx costs.

GLP-1s and Weight Loss Drugs

While not necessarily considered a traditional specialty drug, weight loss medications like GLP-1s (Glucagon-like Peptide-1) are growing in popularity—and cost—enough that employers will need to take them into account. GLP-1s in particular are necessary for treating diabetes, supporting blood sugar regulation, helping with weight loss, and reducing cardiovascular risk, making it even more important to account for in 2024. 2

Recent surveys show that interest in the drug could cause GLP-1 coverage to nearly double in the upcoming years – with weight-loss drugs possibly adding up to 50% to healthcare spend. 1

Tracking patient use, planning for pharmacy and medical benefits to work together, and determining how a plan will help cover the drugs, are pharmacy benefit strategies that can assist plan sponsors in managing their impact on pharmacy spend.

Biosimilars

In 2023, lower-cost alternatives to biologic drugs, biosimilars, took the stage. Multiple biosimilars were approved, one of which was the alternative to Humira, a costly blockbuster drug. The adoption of biosimilars presents an opportunity for extensive cost savings—but this adoption is proceeding slower than expected, with research showing that only 2.4% of Humira biologic claims were replaced by biosimilars. 2 Keeping on top of the changes in the Rx landscape from biosimilars is vital. Transparency with PBMs is particularly critical in order to develop effective strategies and plan for the future.

New Legislation

The pharmacy landscape underwent legislative shifts in 2023 that look to continue in 2024. With national attention from the White House and continuing legislation around PBM transparency, it’s important to watch for the impact new laws and regulations can have on pharmacy. With the announcement of the first ten products subject to negotiation under the Inflation Reduction Act (IRA), 3 it’s absolutely necessary to stay proactive in managing new drugs like biosimilars and GLP-1s, and to remain aware of these rapidly changing external dynamics.

At ProCare Rx, we’re dedicated to putting you first. With claim-level transparent healthcare solutions and the highest level of customer service—we can deliver the best pharmacy claims platform in the industry. As a direct-source PBM, we will equip you with whatever you need to face new industry updates and regulations with full confidence. We’ve got your back.

Interested in learning how we can help you? Talk to an Expert!

Sources:

PROCARE RX AND MC-RX ALIGN BUSINESSES TO FOCUS ON CORE STRENGTH TO BEST SERVE CUSTOMERS AND MARKET

Wed, 04 May 2022 17:30:24 GMT

ProCare Rx, a leading pharmacy benefits administrator and technology company, and its affiliate MC-Rx, a nationwide Pharmacy Benefit Manager, restructure the businesses portfolio to deliver high quality, high-value specialized services to customers!

April 26th, 2022, Gainesville, Georgia – ProCare Rx, a leading pharmacy benefits administrator (PBA), and its affiliate, MC-Rx, a nationwide pharmacy benefit manager, announced today that they have formally realigned the family of businesses. This realignment is designed to leverage the core competency and expertise of each business to best serve its customers in a way that drives more value for partners and constituents.

In 2018, ProCare Pharmacy Benefit Manager, Inc. acquired MC-21, a URAC-accredited Pharmacy Benefits Management (PBM) company. MC-21 and ProCare Pharmacy Benefit Manager were jointly rebranded MC-Rx Powered by ProCare Rx and is now the primary business focused solely on Prescription Benefits Management serving clients in all 50 states, Puerto Rico, St. Thomas, and the U.S. Virgin Islands. ProCare Rx will continue to focus on pharmacy claims processing and other technology–based solutions, leveraging its proprietary hybrid cloud technology.

The other affiliated companies will continue to focus on their core competencies as they have since their inception. “We believe aligning our companies to be individually focused on a dedicated service enables the businesses to be hyper-focused on their unique area of expertise, which allows us to ensure our customers are receiving the highest level of service for their specific needs,” said ProCare Rx Founder, Roger Burgess.

The ProCare Rx family of businesses and the services offered consist of the following:

ProCare Rx

ProCare Rx provides pharmacy claims processing systems and technology to internal clients and external clients through multiple SaaS, PaaS and/or BPO arrangements. ProCare Rx’s proprietary technology is used by thousands of companies to manage millions of their members’ prescription data.

MC-Rx Powered by ProCare Rx

MC-Rx is a full-service, URAC-accredited, Pharmacy Benefits Management (PBM) company. It is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare & Medicaid programs, among others. MC-Rx is responsible for creating cost-effective healthcare by offering clinical utilization management programs, offering more affordable pharmacy channels, negotiating discounts with drug manufacturers and retail drugstores, and encouraging the use of low-cost generics and affordable brands. MC-Rx manages the processing and paying of prescription drug claims, leveraging ProCare Rx’s pharmacy claims processing technology.

ProCare HospiceCare

ProCare HospiceCare is a hospice-specific PBM that offers clients convenient medication ordering and delivery with cost savings recommendations based on their data and monthly ANCC-accredited nurse education, giving clients ultimate control over their program.

ProCare PharmacyCare

ProCare PharmacyCare is a URAC-accredited mail order and specialty pharmacy that is patient and provider oriented, focused on optimizing drug therapies and member health education.

ProModRx

ProModRx operates as a reimbursement and distribution hub offering pharmaceutical and device manufacturers insurance benefit investigation/verification, prior authorization, Rx processing and delivery, financial and co-pay assistance, patient education, and comprehensive data reporting.