At SmithRx, one of our core priorities is strengthening and sustaining independent pharmacies as vital access points in their communities. Too often, independents face unpredictable reimbursement, clawbacks, and shifting terms.

We take a partnership-based approach — working directly with pharmacies to identify the right pricing benchmarks (NADAC, PAC, or AWP when appropriate) and build models that eliminate opacity, ensure fair and predictable reimbursement, and give pharmacies full visibility into their reimbursement.

Our goal is to create a transparent, sustainable model that supports independent pharmacies’ long-term viability while ensuring members continue to have trusted local access to affordable medications.

A Pharmacy Benefit Manager (PBM) manages prescription drug benefits on behalf of health plans, employers, unions, and government programs. PBMs serve as intermediaries between drug manufacturers, pharmacies, and health insurance plans to manage prescription benefits and process drug claims.

PBMs work with drug manufacturers and pharmacies to negotiate prescription drug costs and determine how medications are covered and reimbursed. They secure discounts from pharmacies and rebates from manufacturers, aiming to reduce overall expenses for health plans and patients. PBMs also manage formularies, leverage clinical reviews to ensure appropriate use, and process prescription claims.

Legacy PBMs are typically long-established organizations tied to insurers and pharmacies. They often use opaque pricing structures that hide the true cost of medications from employers so they can pad their own margins. 

Modern PBMs, like SmithRx, are focused on transparency, fiduciary alignment, and executional pharmacy benefits that make a meaningful difference on businesses’ pharmacy spend and member experience.

Yes, most legacy PBMs are owned by large insurers (e.g., Express Scripts by Cigna). By contrast, SmithRx is independently owned and designed to align with the best interests of employers and members.

Legacy PBMs often profit through opaque methods like spread pricing and rebate capture. SmithRx passes 100% of discounts and rebates directly to clients and instead makes money only from straight-forward per-member, per-month administrative fees.

PBMs can negotiate formulary placement and rebates with manufacturers. SmithRx ensures transparency when it comes to the price paid for drugs—and then passes all savings and rebates to clients.

A formulary is a list of medications covered by a plan. It includes generics, biosimilars, and brand-name drugs and products organized by cost tiers and chosen based on clinical efficacy, safety, and cost-effectiveness.

These are medications not included in a plan’s formulary. They may be excluded due to cost, available alternatives, or clinical factors. Non-formulary drugs may require a special request for coverage.