Illuminate Rx: Pharmacy Benefits Reimagined

Pharmacy benefits can be complex, with rising costs, intricate rebate structures, and detailed contracts that require careful navigation. Without the right tools, insights, and options, managing pharmacy benefits can feel overwhelming to benefits advisors and their self-funded employer clients.

RxBenefits wants to change that dynamic. As the country’s first pharmacy benefits optimizer (PBO), RxBenefits has long connected its clients with a range of pharmacy cost containment and service enhancing options that deliver better outcomes and predictable plan economics over the long term. Its one-of-its-kind marketplace model empowers clients to simultaneously compare competing offers from all three of the nation’s leading PBMs, augmented by an array of proprietary cost containment solutions and award-winning professional services.

Now, with the addition of Illuminate Rx to its marketplace, the PBO is empowering self-funded employers to also assess the value of a transparent pharmacy benefits manager (PBM) arrangement alongside its traditional options.

Adding More Power to the RxBenefits Marketplace

The introduction of Illuminate Rx enhances the RxBenefits marketplace by expanding options beyond the nation’s leading PBMs, providing employers with a purpose-built, transparent alternative. This addition reflects RxBenefits’ mission to empower clients with more choice and independence, ensuring they find the right fit for their unique needs.

"Illuminate Rx is not a replacement for the traditional PBMs that have long been part of our marketplace. Instead, it serves as an additional option for clients to consider," said Whitney Reboulet, Senior Vice President of Account Management. "Designed by pharmacists, Illuminate Rx is purposefully tailored to address the needs of employers grappling with out-of-control spending on specialty medications and GLP-1s. Beyond its lowest net cost orientation, it provides an additional option for clients seeking greater flexibility to customize their formulary or network."

For more than 30 years, RxBenefits has been a trusted partner, dedicated to helping clients lower pharmacy costs without compromising member care. “Guided by a relentless commitment to innovation and a deep understanding of evolving market dynamics, RxBenefits monitors industry changes to anticipate and meet the future needs of its clients,” said Robert Gamble, CEO of RxBenefits. “Illuminate Rx is a direct result of this forward-thinking approach – a transparent PBM solution designed to deliver greater flexibility, plan-specific customization, and improved outcomes.”

By complementing traditional PBM options with a new alternative, Illuminate Rx empowers employers with distinct utilization characteristics to take control of their pharmacy benefits, aligning solutions with their unique goals and challenges.

Built by Pharmacists and Powered by Data to Deliver Unprecedented Clarity

Illuminate Rx grew from a simple challenge: If RxBenefits’ pharmacists could design a PBM from scratch, what would it look like?

The answer: one built around outcomes – not rebates or complexity. Employers using Illuminate Rx benefit from:

• Claim-level visibility into drug pricing, rebates, and plan performance
• Flexible formularies and fulfillment partners including Amazon Pharmacy, Costco Pharmacy, and Mark Cuban Cost Plus Drug Company
• Clarity in specialty drug pricing, with generics and biosimilars prioritized when appropriate to manage costs effectively
• Robust clinical support through pharmacist-led utilization management, ensuring members receive the right treatment at the right time, dosage, and cost

Illuminate Rx also provides clarity around the 'specialty' label, helping employers better understand and manage costs associated with these medications. Members can shop across the network for the lowest net cost instead of being limited to a single specialty pharmacy network. By focusing on outcomes, employers can closely manage budgets while preserving clinical integrity.

One Size Never Fits All

No two employers are alike – and their pharmacy benefits shouldn’t be, either. Some employers need to tightly control costs, while others prioritize maintaining a wide-open benefit with minimal member disruption. Most, however, fall somewhere on the sliding scale between these two extremes. RxBenefits understands how to strike this balance and empowers benefits advisors and employers to design pharmacy plans that align with their specific utilization patterns, goals, and priorities.

“If you look at one client, you’ve seen one client,” said Kyra Hagan, Senior Vice President, Marketing and Communications. “RxBenefits’ marketplace of PBM options is the first key to meeting clients where they are on the sliding scale between cost containment and access. The addition of Illuminate Rx to the marketplace takes it a step further, offering new options for tailored plans that address the unique nuances of each client’s pharmacy benefit.”

With Illuminate Rx, employers can choose from two different approaches and layer further customizations to create a plan that is as unique as their employee demographics and organization’s goals to create a benefit that feels tailored, not templated:

1. Optimized care model: Prioritizes clinical efficacy, safety, and cost-effectiveness, emphasizing medications selected for therapeutic value and patient outcomes.
2. Open-access model: Balances accessibility with clinical management, giving members access to commonly used medications while managing costs for expensive specialty and high-utilization brand therapies.

Transparency That Delivers

Transparency is a promise often discussed in the industry, but Illuminate Rx puts it into practice by providing employers with clear visibility into drug-level pricing, rebates, and plan performance – all supported by clean contracts with no spread pricing or hidden fees.

“Transparency to me is having the appropriate level of data and analytics to make decisions around the plan that you're deploying for your employees, understanding the available options, and evaluating the value they will deliver,” said Nathan White, Chief Client Officer.

That level of clarity allows employers to act proactively – whether during sales cycles, mid-plan year, or ahead of renewals – helping them make informed, timely decisions and manage costs more effectively.

Why Now Matters

The timing of Illuminate Rx isn’t accidental. Pharmacy costs – from GLP-1 medications to specialty therapies – are climbing fast. Budgets are tightening, and employers are facing tough challenges trying to balance sustainability, member experience, and long-term value.

“Increasingly, employers are seeking plans that balance rebates with real lowest-net-cost management,” said Gamble. “They want strategic and sustainable cost containment options that support their fiduciary responsibility and reflect their commitment to meet their plan members’ needs. For many of those clients, Illuminate Rx offers a valuable alternative.”

The Future of Pharmacy Benefits

Illuminate Rx represents the next evolution of the RxBenefits marketplace and strengthens a model that has well-served self-funded employers for decades.

“Employers want something that is unique and personalized to them,” said Gamble. “Illuminate Rx gives them choice, clarity, and control.”

With Illuminate Rx, RxBenefits continues to set a standard for pharmacy benefits where outcomes matter most, employers are empowered, and members know their care is never compromised.

It’s what the industry has long needed: informed options, enlightened results, and real control.