Strategic Consulting.

Strategic Consulting.

All we Need:

All we Need:

Your claims and the contracts that govern them.

From there, we evaluate how:

The benefit is designed

How it operates

Where value is gained or lost.

Audit Function

Reprice in Minutes

Top 10 Drug Spend

Utilization Analysis

Drug Channel Analysis

Disruption Report

High-Cost Claimants

Explore Tools

Minimum 20% Savings

with our Audit Tool

Before and After Drug Spend after Appro-Rx Audit and Consulting

In millions ($)

Benefit Plan Assessment ✶

Benefit Plan Assessment ✶

Take control

of your pharmacy benefit spend with a

Appro-Intel Audit

    • Current PBM contract

    • Twelve-month file of claims and rebate activity.

      Note: Plan sponsors are entitled by law to receive their claims data in a timely manner, even if a vendor suggests otherwise.

    • Independent review in minutes using real claim data, contract terms measured against industry standards, and factual financial outcomes.

    • Understand your true bottom line without assumptions, personal bias, or vendor influence.

    • Map contract language to real claim and rebate data

    • Show how definitions, pricing structures, specialty terms, and rebate mechanics translate into actual plan cost with supporting evidence

    • Clarify whether the plan is performing as intended

    • Net cost clarity

    • Trend analysis

    • Specialty impact

    • Hidden exposure areas

    • Biosimilar opportunities

    • Pricing inconsistencies

    • Where value is gained or lost

    • Renegotiate terms and correct weaknesses

    • Validate vendor performance

    • Capture savings while maintaining member access

    • Turn complex pharmacy economics into simple next steps

    • We walk you through the results and answer any questions.

    • You can use the findings to improve performance with your current PBM or explore Appro-Rx or trusted partners as an aligned alternative.

    • There is no risk and the potential for significant reward.

Plan Design Review ✶

Plan Design Review ✶

Take control

with our Pharmacist Designed, Guideline-Driven

Plan Design and Claim Review

    • Current PBM Formulary

    • Twelve-month file of claims and rebate activity

      Note: Plan sponsors are entitled by law to receive their claims data in a timely manner, even if a vendor suggests otherwise.

    • Evaluates the pharmacy benefit through a clinical and economic lens

    • Applies pharmacist-led judgment to formulary and claims behavior

    • Surfaces how market dynamics influence cost and access

    • Frames opportunities around patient outcomes and benefit integrity

    • Net cost optimization opportunities

    • Specialty and generic utilization trends

    • Specialty impact on total spend and interchange opportunities

    • Lowest-net-cost formulary options

    • Biosimilar savings opportunities

    • Pricing inconsistencies across channels

    • Where value is gained or lost in the benefit structure

    • Prior authorization, quantity limit, and day supply optimization

    • Optimize existing plan design without disrupting member access

    • Use the plan’s own data to capture savings already within reach

    • Implement changes often avoided under traditional PBM models

    • Align decisions to true net cost rather than vendor incentives

    • Analyze how claims are adjudicated and how formulary rules are applied

    • Review drug selection logic, pricing methodology, and channel routing

    • Compare covered therapies to clinically equivalent alternatives

    • Evaluate the role of spread, rebates, and contractual incentives

    • Document divergence from lowest-net-cost execution

    • Walk through findings with a clear path to implementation

Connect With

A Sales Rep.

Andy.Suittor@ApproRx.com

Jordan.Mullins@ApproRx.com