SmithRx is a modern pharmacy benefit manager (PBM) built specifically for mid-market self-funded employers. We charge one flat admin fee of $10 per member per month, and that fee is the only way we get paid. Every dollar of drug cost and every rebate passes through to the plan.

Legacy PBMs make money on the spread between what they charge you and what they pay pharmacies, and on rebates they keep. That ties their revenue to higher drug prices. A flat fee removes that conflict: we do better only when your plan spends less.

Our Fee: A Flat $10 PMPM

The $10 PMPM fee covers everything we do:

• Claims administration, pharmacy network and formulary management

• Dedicated account management and US-based member support

• Clinical programs, specialty management and prior authorization

• Our cost-savings programs, including Drug Pathways, with dedicated case agents

• Full claims-level reporting and audit rights

There are no implementation fees, data fees, per-claim fees or program add-ons.

Backed by a 1.5x ROI Guarantee

If the savings our programs deliver are less than 1.5x the program portion of your admin fee, we refund the difference every year.

Measuring What Matters: The Power of Total PMPM

As you consider your PBM partnership and its related costs, it can feel all too easy to get lost in the details. But at the end of the day, what really matters is the overall value. This is where Total PMPM comes into play.

Think of it like buying a car. You wouldn't focus solely on the cost of manufacturing or just the price of the engine. What matters is the total cost of ownership. Similarly, in PBM partnerships, looking at individual components (like discounts or admin fees) in isolation doesn't give you the full picture.

Total PMPM represents the all-in amount you pay every month for pharmacy benefits, including admin fees, drug costs, and any other related expenses. It's calculated as:

Total PMPM = (Admin Fees + Drug Costs) / Number of Members / Number of Months

For example: If admin fees are $10 PMPM and average drug costs are $83 PMPM, the total average Total PMPM would be $93.

This comprehensive metric allows for fair comparisons between different time periods or PBM providers, provides transparency into your true pharmacy benefit expenses, and helps you track the impact of cost-saving initiatives over time.

At SmithRx, our fee structures are designed to optimize this metric through transparent pricing, passing through all rebates and discounts, focusing on cost-effective drug options, and continuous innovation.

SmithRx's Total PMPM vs. Competitors

When it comes to your pharmacy benefits program, remember to focus on metrics you can measure and rely on. Complex fee structures and lofty promises are distractions.

FAQ

What does SmithRx charge? A flat $10 per member per month admin fee. It is our only revenue.

Who is SmithRx built for? Mid-market self-funded employers, typically 500 to 10,000 employees, who want transparent pass-through pricing.

Does SmithRx make money on spread or rebates? No. 100% of drug pricing and rebates pass through to the plan.

Is the $10 a maximum or a flat fee? It is a flat fee that covers all services, including our cost-savings programs.