Cost concentration
A small share of claims carries a large share of pharmacy spend. When that concentration sits in a handful of therapies, incremental savings elsewhere rarely close the gap.
Pharmacy cost containment, reimagined
A better path for high-cost pharmacy claims.
RxToYou connects self-funded health plans with certified Tier-1 pharmacies worldwide — identifying high-cost claims, sourcing the lowest net-cost option, and managing every order in one portal.
57% average savings per claim
on high-cost claims where an alternative pathway is identified
Built for self-funded plans Layers onto your existing strategy Integration-ready Member-centered
Modeled example — assumptions below
RxToYouClaims overviewRT
ACTIVE OPPORTUNITIESHigh-cost claims
Last 30 daysHigh-cost claims48720% of 2,435
Opportunities34170% of high-cost
Projected savings$544kannualized
Net-cost comparisonPlan cost · Alternative
Specialty claim #4812$18,750 claim · alternative pathway identified
−49%ReviewCLAIM OPPORTUNITYLower-net-cost path found
−$9,188Modeled on 2,435 claims reviewed, of which 487 are high-cost; an alternative pathway identified for 70% of those; a $2,800 average high-cost claim; and 57% average savings. The highlighted claim is a specific $18,750 example at 49% savings, not the average. Not a report of realized client results.
The challenge
A small number of claims. An outsized share of plan spend.
The hard part isn't knowing that high-cost claims exist. It's finding a defensible alternative for each specific claim, fast enough to matter, without disrupting the member already on therapy.
Limited levers
Formulary changes, rebate negotiation and utilization management all have real limits once a member is stabilized on a specific medication.
Operational drag
Even when a better option exists, acting on it means sourcing, documentation, coordination and follow-up that most benefit teams aren't staffed to absorb.
One connected solution
From claim signal to delivered therapy.
Analytics, global sourcing and operational workflow in a single pathway — so every opportunity has a clear next step and a clear owner.
Identify
Claims data is analyzed to surface the high-cost claims where a different pharmacy pathway could materially lower plan spend.
Source
Each eligible claim is matched against certified Tier-1 pharmacies worldwide and compared on true net cost — not list price.
Manage
Orders, documentation, approvals and status live in one secure portal, so nothing important depends on an email thread.
Measure
Savings are reconciled claim by claim and reported back to the plan, advisor or TPA in the terms they already use.
Purpose-built technology
A single source of truth for pharmacy cost containment.
Move past spreadsheets, status-chasing and disconnected handoffs. The RxToYou portal gives every party one operational view — from first claim review through fulfillment and savings reconciliation.
- Actionable claim intelligence
Prioritize opportunities by value and status, with the reasoning behind each recommendation visible rather than buried.
- Connected pharmacy workflows
Coordinate sourcing, documentation and fulfillment across partners without leaving the platform or losing the thread.
- Role-based, configurable access
Give plans, advisors, TPAs and pharmacy partners exactly the view they need — including white-label and API options.
- Reconciliation and reporting
Track realized savings claim by claim, and export the reporting your stakeholders already expect to receive.
ILLUSTRATIVE WORKFLOW
CLAIM SIGNALHigh-cost claim flagged
01RxToYou intelligenceEVALUATING LOWEST-NET-COST PATHWAYS
CATier-1 pharmacyELIGIBLE
UKTier-1 pharmacyBEST NET COST
AUTier-1 pharmacyELIGIBLE
Global sourcing, rigorous standards
A curated pharmacy network — not an open marketplace.
Every pharmacy in the RxToYou network is selected and monitored against a consistent standard. Breadth only matters when it comes with accountability.
Certified Tier-1 partners
Partners hold international Tier-1 pharmacy certifications. Onboarding confirms licensure in the home jurisdiction and reviews each pharmacy against a consistent standard.
True net-cost comparison
Options are evaluated on delivered net cost to the plan, including the costs that list price tends to obscure.
Verifiable drug pedigree
Sourcing, handling and delivery are documented so an order’s pedigree can be verified and traced end to end.
Ongoing monitoring
Network performance is reviewed continuously rather than only at the point of onboarding.
Built to work with you
One platform. Multiple paths to value.
RxToYou is designed to extend what you already do — not to replace the relationships and strategy that are working.
Self-funded plans
Add a focused cost-containment layer without rebuilding the benefit strategy that already works.
- Visibility into which claims are actually actionable
- Savings reconciled and reported claim by claim
- A member experience your team can stand behind
Benefits advisors
Bring clients a practical, differentiated answer to the high-cost pharmacy claims that dominate renewal conversations.
- A concrete strategy to introduce, not just a vendor
- Client-ready reporting on realized impact
- Support through implementation and beyond
TPAs & PBMs
Extend your capabilities through a configurable platform, an established pharmacy network and integration-ready workflow.
- White-label and API options
- Role-based access for your teams and clients
- Workflow that fits alongside existing systems
The member experience
Technology forward.
Human where it matters.
Cost containment only works if the member stays on therapy. The process is built so the person at the center of the claim experiences support rather than friction.
Introduction
The member is walked through what the program is, what changes for them, and what does not.
Clinical review
Eligibility and appropriateness are confirmed before anything moves forward.
Coordination
Prescriptions, documentation and scheduling are handled with the member, not handed back to them.
Ongoing support
Refills, questions and status updates have a named path — not a general queue.
Trust and governance
Built for the scrutiny a health plan brings.
Pharmacy decisions carry real consequences. The platform is designed so that every recommendation can be explained, evidenced and audited.
Data protection by design
Access is role-based and least-privilege, sensitive data is handled on a need-to-know basis, and every action in the portal is attributable.
Transparent methodology
Each recommendation shows the comparison behind it, so plans and advisors can evaluate the reasoning rather than trust a number.
Aligned to the plan
Decisions center on the lowest net cost and a reliable path for the member — not on which option is easiest to fulfill.
Common questions
The questions plans ask first.
Does RxToYou replace our PBM?
No. RxToYou is designed as a focused cost-containment layer that works alongside the benefit strategy and partners you already have. The goal is to address the specific high-cost claims where an alternative pharmacy pathway produces a materially better outcome.
What does implementation involve?
Implementation centers on getting the right claims visibility in place and agreeing how opportunities are reviewed and approved. Because the platform is integration-ready and requires no separate database or CMS on your side, the work is largely about data access and workflow agreement rather than technical build.
How are pharmacies selected?
The network is curated rather than open. Partners hold international Tier-1 pharmacy certifications, onboarding confirms licensure in the home jurisdiction, and network performance is monitored on an ongoing basis. Options are then compared on delivered net cost to the plan.
How do you verify what the member receives?
Every order carries a documented drug pedigree. Sourcing, handling and delivery are recorded so the chain from the certified pharmacy to the member can be verified and traced end to end, rather than taken on trust.
What changes for the member?
The member is introduced to the program, their eligibility and clinical appropriateness are confirmed, and coordination is handled on their behalf. Refills, questions and status updates have a named path, so continuity of therapy is protected throughout.
How is savings measured and reported?
Savings are reconciled claim by claim against what the plan would otherwise have paid, and reported back to the plan, advisor or TPA in the terms they already use for benefit reporting. RxToYou models average savings of 57% on claims where an alternative pathway is identified, which it expects for roughly 70% of the high-cost claims it reviews. High-cost claims are typically a minority of a plan’s claim volume but carry a disproportionate share of its pharmacy spend.
Can RxToYou run under our own brand?
Yes. For TPAs, PBMs and partners who need it, the platform supports white-label presentation and API access, with role-based views configured for your teams and your clients.
A better path starts here
Make every high-cost claim an opportunity.
Let's look at how RxToYou could extend your pharmacy strategy with smarter sourcing, simpler operations and clear savings visibility.
Start a Conversation Or email info@rxtoyou.com