We Put Our Fee at Risk. That Is Not Something Traditional PBMs Do.
Step 1 — Underwriting
An actuarially underwritten, forward-looking PMPM cap is established before the plan year begins. Underwriting is grounded in your population's actual drug mix, utilization patterns, and trend data.
Step 2 — Risk Transfer
Rebate-underperformance risk is transferred off the plan. If actual spend exceeds the cap, Appro-Rx covers the difference. The PBM fee is at risk — there is no ability to profit from higher costs or to offset poor performance with retained rebates.
Step 3 — Quarterly Reconciliation
All projections are documented and reconciled quarterly for complete accountability. There is no waiting until year-end to find out whether the guarantee held — the data is live and the reconciliation is continuous.
Step 4 — Year-End Settlement
If the cap holds, the plan got exactly what it was promised: a budgetable, predictable pharmacy line item. If actual spend exceeded the cap, Appro-Rx makes the plan whole — dollar for dollar.
Under the PMPM Guarantee, rebates stop mattering to the plan. The cost is fixed upfront. This is the functional elimination of rebate dependence — exactly what policymakers and employers actually want, but have struggled to articulate or implement.
Result for the Employer
Pharmacy goes from your most volatile cost to your most predictable one. Budgeting becomes real. Cash flow becomes stable. Year-over-year planning becomes possible.
Result for the Broker
Renewals become defensible. The PMPM Guarantee is the first pharmacy story a broker can defend at renewal — without hoping the guarantee "reconciles in their favor."
Result for the TPA & Stop-Loss Carrier
Underwriting-grade Rx certainty. Pharmacy volatility — historically the largest source of stop-loss surprises — gets governed and documented. Stop-loss economics improve. Renewal conversations get easier.
Traditional PBM Guarantee
Backward-looking. Measured against contract minimums after the fact.
Narrowly defined. AWP-only. Generic-only. Ingredient-cost-only.
Engineered to be met. The PBM keeps the difference if it overperforms.
Reconciliation is annual, opaque, and PBM-controlled.
Appro-Rx PMPM Guarantee
Forward-looking. The cap is established before the plan year begins.
PMPM total cost basis — the metric that actually matters to the plan.
Real risk transfer. Appro-Rx absorbs overage. Plan keeps overperformance.
Reconciliation is quarterly, documented, and auditable.
Get a PMPM Guarantee Projection for Your Plan.
Submit a recent claims extract. We deliver a PMPM projection grounded in your actual data — not a sales pitch.
