How Employers Thrive with Self-Funded Plans

As healthcare costs continue to rise, more employers are making the switch to self-funded health plans. This model offers a powerful combination of savings, flexibility, and transparency—allowing employers to take control of their benefit design and pharmacy spend.

But while the upside is clear, success in self-insurance depends on more than just the structure of the plan. It depends on how well you’re supported.

At SmithRx, we help employers not only transition to self-funded models, but thrive in them—by simplifying the complex, reducing pharmacy costs, and giving you tools to make confident, data-driven decisions.

Why Employers Are Choosing Self-Funded Health Plans

Fully insured plans lock employers into high premiums, limited visibility, and one-size-fits-all options. In contrast, a self-funded plan puts you in control of:

• Costs – by avoiding carrier markups and state insurance taxes

• Plan design – so you can tailor benefits around your population’s needs

• Data – offering real-time insights into claims, utilization, and trends

• Vendors – letting you choose best-in-class partners, not bundled options

This model is especially powerful for employers looking to contain pharmacy benefit costs, adopt emerging therapies wisely, and respond quickly to changes in the market.

What Makes Self-Funding Successful? A Clear Strategy and the Right Partners

The most successful self-funded employers build a support system that includes a transparent pharmacy benefit manager (PBM), an experienced Third-Party Administrator (TPA), and a proactive broker or consultant.

What matters most isn’t just access to data—it’s what your partners do with it. And that’s where SmithRx makes the difference.

How SmithRx Helps Employers Thrive With Self-Insured Benefits

We’ve built our entire model to support employers who choose self-funding—not just in theory, but in day-to-day execution. We understand that choosing a self-insured plan is a major strategic decision, and our role is to help you make it work with transparency, consistency, and measurable results.

Transparent, Flat-Fee Pricing

SmithRx operates on a simple, flat per-member-per-month (PMPM) admin fee. That’s the only way we get paid. We don’t retain rebates, mark up claims, or bury costs in complex contracts. Every dollar from manufacturers goes back to the plan sponsor. Employers have real-time access to all rebate and claims data, so they can track performance and prove savings without guesswork.

Active Cost Optimization Through the Pathways Engine

Our proprietary Drug Pathways Engine is the heart of our savings strategy. It continuously evaluates prescriptions and fulfillment methods to identify lower-net-cost alternatives—then helps put those changes into action. We work directly with prescribers and members to make clinically appropriate switches, ensuring savings are not just surfaced, but realized.

Dynamic Program Design With Connect360

Through Connect 360, employers get access to a suite of cost-savings and clinical programs that evolve with the market. From biosimilar adoption to savings through partners like Cost Plus Drugs, Connect 360 is designed to keep your plan aligned with current best practices without adding administrative burden. These programs are actively managed and continuously refreshed by our (spectacular) clinical team.

High-Touch Support for Employers and Members

Every SmithRx client is supported by a dedicated team that handles implementation, ongoing strategy, and day-to-day service. That includes pharmacy benefit modeling, stop-loss reporting support, formulary guidance, and direct engagement with high-cost or complex member cases. For members, our licensed pharmacy guides provide white-glove navigation from day one. With dedication like this, members don't need to worry about transfers or repeating their story.

Why Self-Funded Plans Work—When They're Done Right

Self-insured benefits give employers more control than ever. But with control comes responsibility—and that’s why your PBM matters.

With SmithRx, self-funded clients gain the structure, transparency, and clinical partnership they need to reduce drug costs, improve member experience, and hit their goals.

Want to make your self-funded pharmacy strategy stronger? Let’s talk.