EXPERTS IN PHARMACY BENEFITS

Leading the Way to an Elevated PBM Experience

PRxS offers a best-in-class specialty drug program designed to enhance clinical focus on the member and disease, rather than the transactional management frequently offered by others. 

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TAILORED SOLUTIONS, EMPOWERING HEALTH

PRxS Overview

PinnacleRx Solutions is a leading provider of pharmacy benefit management services focused on optimizing medication therapy outcomes and reducing costs for employers and health plans. Our comprehensive solutions include formulary management, clinical cost containment programs, and patient engagement strategies designed to improve health outcomes and enhance the value of pharmacy benefits. With a commitment to innovation and customer service, PinnacleRx Solutions partners with clients to deliver personalized and effective PBM solutions. 

  • Custom Plan Designs
  • Transparency and Visibility
  • Monitor and Reporting
  • Customized Formularies
  • Health Management
  • Independently Owned
WE'RE EXPERTS IN PHARMACY BENEFITS SO YOU DON'T HAVE TO BE

Why Choose PRxS?

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20+ years in health care claims and benefits

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67,000+ pharmacies nationwide

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Traditional and transparent pricing available

OUR PROGRAMS

Clinical Intervention Savings Program

  • Not denial-based; denials are not calculated in any savings projections
  • Based on peer-to-peer discussions between PRXs Clinical Pharmacists and Prescribers
  • For new plans, first year savings range from 18%-22% or Specialty drug spend with additional savings in years two (10%-12%) and three (8%-10%)
  • Clinical education and provider detailing accounts for 2/3 of total savings year over year
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Formulary Guide

The formulary reference guide is a useful aid to understanding your drug benefit program. The formulary is a list of drugs reviewed and approved by an independent committee of physicians and pharmacists. The formulary includes drugs that are commonly prescribed by physicians, clinically useful, and cost-effective.
 

Formulary Guide

The formulary reference guide is a useful aid to understanding your drug benefit program. The formulary is a list of drugs reviewed and approved by an independent committee of physicians and pharmacists. The formulary includes drugs that are commonly prescribed by physicians, clinically useful, and cost-effective.
 
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Mail Order

Our customized mail order program is designed to save members time and money. Our mail order program offers free delivery of medications to your home or preferred shipping address. We recommend this service for members who take a medication on an ongoing basis.
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Top-Tier Rebate Programs

Extensive interaction between PinnacleRx Solutions and prescribers ensures optimal outcome for members.  PinnacleRx Solutions pays rebate estimates within 30 days of period close, and then provide a true-up in the traditional 100-day cycle. This allows plans to realize their rebate funding in the quarter immediately following utilization.

Top-Tier Rebate Programs

Extensive interaction between PinnacleRx Solutions and prescribers ensures optimal outcome for members.  PinnacleRx Solutions pays rebate estimates within 30 days of period close, and then provide a true-up in the traditional 100-day cycle. This allows plans to realize their rebate funding in the quarter immediately following utilization.
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Unique tools for small businesses

Pinnacle Employer Resource Center (PERC) is a free tool available for employers so they can easily access and update health benefits information. We offer one-on-one program training so you can begin accessing your plan information immediately and understand how to maximize all that this resource has to offer.
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CASE STUDY: CLINICAL DIALOGUES UNLOCKING PRESCRIPTION SAVINGS

The PRxS Clinical Intervention Savings Program (CISP) Success Story

  • PRxS CISP captures high-dollar claims and collaborates with prescribers on potential alternative therapies.
  • PRxS and Provider work together to find less-costly alternatives.
  • Savings between the two therapies is recorded.
  • Applies to all eligible, both existing and new, prescriptions within a given plan. 

Background

Client is a Self-Funded Lending Institution

  • 1,450 members
  • $1.8m annual drug expense

Challenge

The broker and CEO noted concerns around rising specialty drug spending and inflation.

Solution

  • Launched CISP
  • Established PRxS as resource for providers

Results

Actual Savings

  • $397k in the first two quarters
  • $549k in the first 12 months
  • $338k in Year 2

Projected Future Savings

  • $219k for Year 3

Member Health Outcome

7 members spared from serious Adverse Drug Reactions/Interactions as the PRxS clinical team shared information with providers that they did not already know from other providers. 

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PHARMACY LOCATOR

Find a Pharmacy

PinnacleRx Solutions includes a retail network of more than 67,000 pharmacies nationwide. Search for a participating pharmacy near you.

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Contact Us

Have any questions about pharmacy benefit management, your benefit plan, or need additional support? We can help!​

Learn More

Want more information on Pinnacle Rx Solutions? Visit our website prxsolutions.com. 

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