Straight answers, no fine print required
Everything employers usually ask before switching to a transparent PBM.
What does "true pass-through pricing" mean?
We bill what pharmacies are paid on our contracts — no spread pricing or hidden add-ons. Our admin fee is disclosed and fixed, and price concessions owed to the plan are passed through in full.
Do you allow audits and full transparency?
Yes. Contracts and price-concession terms are available for a full annual audit, with 30 days' written notice, and plan sponsors receive reporting that reconciles plan billing to pharmacy reimbursement.
Will you sign performance guarantees?
Yes — service and cost guarantees with remedies tied to measurable outcomes (e.g., PMPM trend, PA turnaround, member satisfaction).
What's your service philosophy?
Focused, tailored, and fast. We minimize disruption, resolve issues at first contact, and treat members like people — not ticket numbers.
How do members get help at the pharmacy counter?
Our 24/7/365 bilingual help desk can conference with the pharmacy in real time to resolve rejects, verify coverage, or identify clinically appropriate alternatives.
How do you approach clinical care and formulary?
Evidence-based criteria, developed with your Pharmacy & Therapeutics Committee, and programs that balance speed to therapy, safety, and total cost of care. Formularies prioritize net-cost value — not rebate size.
- Prior authorizations aligned to current clinical evidence
- Members supported with education and outreach
- Care navigation for complex and specialty therapies
How do you handle manufacturer rebates and assistance?
Plan-owed amounts are passed through and reported monthly. When copay assistance exists, we coordinate compliantly to reduce out-of-pocket cost without shifting hidden costs back to the plan.
Can you integrate with our TPA and existing vendors?
Yes — standard eligibility and accumulator files, secure data feeds, and APIs where appropriate, with testing and go-live validation.
What reporting will we receive?
Claims, trend, and utilization dashboards; price-concession remittance detail; and audit-ready files that show exactly what pharmacies were paid vs. what the plan was billed — at no extra cost.
Is the network narrow? Can members use local pharmacies?
We maintain broad access and clearly communicate any plan-specific channel optimization (e.g., 90-day retail or home delivery) so members can keep convenient options.
Do you disadvantage independent pharmacies?
No. We avoid policies that discriminate against independents and focus on fair terms that preserve member access and plan value.
How long does implementation take?
Most implementations take 60–90 days based on data readiness and customization. Twelve months of historical claims and open prior authorizations are migrated at no additional cost.
What do you need from us to get started?
Prior PBM data (12–24 months), current plan design, eligibility specs, and vendor contacts. We'll return a project plan with owners and test milestones.
How do you handle security and privacy?
HIPAA-compliant data handling, encryption at rest and in transit, access controls, and vendor risk assessments with periodic audits.
Still have questions?
Talk with a TruthRx expert about transparent plan design and member support.