A Conversation with Robert Gamble, CEO of RxBenefits

Pharmacy benefits optimizer (PBO) RxBenefits recently launched Illuminate Rx, a new PBM, designed by pharmacists for brokers and self-funded employers, according to a company news release.

RxBenefits is the country’s first PBO, offering multiple PBM options, including the "big three": CVS Caremark, Express Scripts and OptumRx.

Illuminate Rx launched Sept. 10.

Robert Gamble, CEO of RxBenefits, recently sat down with Managed Healthcare Executive to discuss the launch of Illuminate Rx, what makes it unique and what’s next for the company.

Robert Gamble

What is Illuminate Rx?

Illuminate Rx is a brand-new, modern PBM that provides an option for brokers and self-funded employers.

It is a pharmacist-designed, clinically led approach, and we have a world-class group of clinicians that have driven a lot of results on our platform over many years. We were able to charge them with the fun task of going into the lab and saying, ‘how would you design a clinical first approach for pharmacy benefits?’ The result of that is Illuminate Rx.

Benefits are complicated. We want to use our whole platform to demystify some of those things. From a tech perspective, LLMs and AI are in their strengths to help people get information easier in a complex world. So, we are leveraging some of that, both externally and internally, to help make that simpler.

Why offer Illuminate Rx right now?

It's part of how we think about innovation at RxBenefits.

A big piece of what we do is listening to our clients, looking at market feedback and trying to innovate over time to provide the best options for the pharmacy benefits landscape.

Based on market feedback and what we're seeing in the marketplace, there is a need for something different within pharmacy benefits.

Illuminate Rx is a way for us to deliver not just something that's transparent, but something that is clinically driven, designed by pharmacists and creates an opportunity for self-funded employers to capture something that they can't capture currently on our platform.

In a news release, you said, "Illuminate Rx sets new standards for transparency." How?

Transparency for Illuminate Rx is about clarity, data and timing.

What we don't think exists now is the ability for a plan sponsor to get granular-level data—things like drug-level rebates at the quantity level and more transparency into the network in terms of the cost at the pharmacy—and getting that data with the clarity of timing of them to decide that's really going to drive a result

When plan sponsors are selecting Illuminate Rx during the sales and prospecting process, during the plan year, or when they're making benefit changes in elections for a future year, they need the clarity of that data. They need it quickly so they can make decisions about their benefit and about things that can be preventative for trends.

Who is the specialty pharmacy that you are working with?

We'll work with several specialty pharmacies like Amazon Pharmacy, Costco Pharmacy and Mark Cuban Cost Plus.

How will the formulary be structured?

Formulary design is critical to success from a trend management perspective.

What we've really wanted to say is, ‘What can we drive in terms of clinical results and clinical shift with formulary design? Then pairing that with the ability to have plan exclusions that don't impact your rebate contract.

That gives sponsors the opportunity to select from different formularies but also have flexibility on other plan exclusions that aren't interfering with what they might get on their rebate contract. All the while, with that transparency of having drug level, quantity level, and rebate data, they can make informed decisions about what that formulary and/orthose plan exclusions could be that might suit their needs best.

How does RxBenefits define specialty?

The thing about RxBenefits, and certainly for IlluminateRx, is the definition of specialty is not going to impact whether you're rebate eligible or anything about the economics of that claim.

You have in other spaces within PBM; this word is defined as "specialty," it gets treated a certain way, the economics are impacted, and that creates a lot of cloudiness and, in some cases, misaligned incentives about which drug gets dispensed.

With Illuminate Rx, all of that is very clear. It doesn't matter whether it's designated a specialty or not a specialty; you're going to know what economics you get.

What’s next for RxBenefits?

There are two things we will continue to innovate on. One, what are the additional things we can use our clinical expertise on to influence both the member experience and the cost trend management? It's a very dynamic time in the space, and we look to that theme of flexibility and optionality so that plan sponsors can have ultimately make the right decision for them, and that they can come to our marketplace to select among multiple PBMs that may be beneficial for them.

Second, from a digital perspective, we have a host of digital tools and platforms that members, benefit consultants and employers can engage with to get the information that they need to make decisions. We know this is a complicated space, and that's not changing anytime soon, and we will continue to invest on the tech side to make that experience easy.