Pharmacy benefit management built for connected care
Through CarelonRx, our pharmacy benefit manager (PBM), we help reduce costs, improve outcomes, and simplify experiences with connected pharmacy care solutions.
A PBM supporting better health and lower costs
Your pharmacy benefit manager should do more than process prescriptions. From pharmacy network management to specialty drug management, CarelonRx approaches pharmacy benefits with a focus on clinical expertise, pharmacy and medical insights, drug spend management, and personalized member support. That means going beyond the basics of prescription management services to help enable safer medication use, better health for members, and lower costs for your business.
With CarelonRx, pharmacy decisions can be informed by clinical data, benefit design, member needs, and a whole-person health context — not just prescription claims.
Pharmacy benefit management reach and results
When a PBM approach is focused on your people and built for business, numbers and trends tell a powerful story.
PBM solutions for today’s pharmacy challenges
Rising drug costs, specialty medication growth, and fragmented member experiences are putting pressure on pharmacy benefits. We help address those challenges through a PBM model that connects pharmacy networks, formularies, integrated insights, clinical programs, digital tools, and personalized support.
Our solutions help organizations manage costs, guide members to clinically appropriate therapies, support medication adherence, and make pharmacy care easier to navigate.
Formulary management
Evidence-based formulary management with a clinician-led strategy and member-first mindset, ensuring each drug list is thoughtfully curated with benefit alignment to promote effectiveness, safety, and value.
Prescription cost management
Programs that provide automatic discount pricing on qualifying generic drugs at the retail counter, and our Cost Relief program to help members access manufacturer copay assistance for certain specialty drugs.
Specialty drug management
Support for managing specialty medication spend across the medical and pharmacy benefits, with whole-health support, predictive modeling, forecasting, utilization management, and consultative reviews.
Pharmacy network management
Network strategies that help members access medications through national, regional, independent, and high-performance pharmacy networks, including home delivery and specialty pharmacy options.
Clinical care with pharmacist support
Clinical support through our Clinical Pharmacy Care Center that helps members navigate medications, adherence, safety, cost, and access, plus 24/7 phone, text, and chat access to pharmacy and specialty pharmacy experts.
Dispensing pharmacy partners
Through pharmacy partners across our ecosystem, members can access support for home delivery, specialty medications, infusion services, and complex care needs. These pharmacy partners are part of a broader connected care network that enables access to quality care and pharmacy services.
Related Articles
1. CarelonRx internal data, 2024.
2. CarelonRx internal data, 2024; overall trend pharmacy + medical.
3. CarelonRx Advocacy book of business, 2024.