RxPricing. The most important part of your business deserves it.

We understand that the more plan sponsors you serve, the larger and more complex your pharmacy network. Managing contracted pricing across clients, delivery methods (retail, mail, specialty), coverage type (brand, generic, specialty), quantity, and price source are additional layers of complexity, leaving the average PBM to manage nearly countless configurations. We built RxPricing because we’ve seen first hand that managing contractual obligations is too important to rely on an industry-agnostic or home-built solution—and that for any modern PBM, this should not only be a core competency, but a true advantage. RxPricing is relied upon by some of the most technology-forward PBMs in the country.

Manage Network, Plan, and Client Pricing

Manage your price schedules and pharmacy networks efficiently, for all of your plan sponsor clients, accounts and groups, and communicate set up and changes to downstream stakeholders. RxPricing workflows and built-in analytics will ensure that you meet contractual obligations to clients, while maintaining a profitable and scalable business.

MAC List Management

  • Create new MAC lists (base, pharmacy, client)
  • Specify MACable drug rules (e.g. supply requirements, brand vs. generic price thresholds) for ongoing MAC management
  • Select and manage against all industry price sources (AWP, PAC, SWP, WAC, NADAC, or Wholesaler-level pricing data)
  • Manage MAC lists at a GCN level or with NDC overrides.

Re-Pricing Analytics

The re-pricing feature within RxPricing will help you maximize your spread by allowing you to create what-if scenarios and immediately see the financial impact of your changes. Modify your MAC list by GPI, GCN and GSN drug classification or specify overrides at the NDC level. Run real-time reports to calculate the current overall effective rate and projected overall effective rate to ensure you’re meeting your client and network guarantees.

Target Tracking and Client Reporting

Attach network and client pricing agreements for quick reference, and ensure that you hit contractually obligated thresholds with RxPricing’s target tracking feature. Whether you wish to set targets at a chain-level, by client, or manually, RxPricing is dynamically designed to report the metrics that matter to you. For users of RxPricing who wish to communicate their performance relative to targets to clients, RxPricing is built to validate, export, and submit to third-parties.

Model the Future, Not the Last 90 Days

For industry leaders managing to annual plan year targets, re-pricing on 90 days of past claims data isn’t enough. Because history never repeats itself. By leveraging proprietary data and forecasts, RxPricing enables you to plan for the real-world, not the past. Our data models are populated to consider inflation, emerging therapies and generic launches, shifting prescribing patterns and market shares, seasonality in consumption, and more.

Robust Claims Integration and Price Sources

  • RxPricing supports datafeeds from the leading integrated drug price sources, enabling you to manage price schedules the way you always have. We currently receive real-time data from five leading drug databases, including AWP, WAC, NADAC, FUL.
  • Adaptive is the only vendor able to ensure complete data consistency through direct integration with claims adjudication systems. RxPricing currently interfaces with FirstRx, Laker, RxClaim, and RxNova.
  • For clients managing networks and pricing in multiple systems or platforms, Adaptive builds integrations that empower you to do you work within a single workflow

Configurable, Role-Based Workflows

RxPricing is designed to give clients complete control. Everything in RxPricing is centered around the concept of a “ticket”. Each ticket is a unique change request that can be issued, reviewed, and enacted based on carefully defined business processes. Our ticket-based workflows will mirror your existing internal change approval processes, usher changes through validating steps (from test to production to claims), and ensure comprehensive change reporting.