MutualRx was created in response to prescription drug benefit plan sponsors frustration with traditional pharmacy benefit managers (“PBMs”). Their relationship was often perceived as not being on the same team. While traditional PBMs offer their services as a prescription drug manager, they are too often a unwanted middleman, where a growing number of plan sponsor clients felt that the information, pricing and services received were too heavily weighted in favor of the PBM.
In a world of rapidly changing technology and self-service automation, the idea of paying inflated mark-ups to support hungry corporate shareholders and bloated organizational structures seems outdated and unnecessary. Plan sponsors asked “why can’t we do this ourselves?” MutualRx agrees, and has put in place the framework and structure to provide a more efficient and cost-effective option for providing the support services required for managing a prescription drug benefit program.
Plan sponsors can now become part of the solution as an equity partner, with all of the benefits associated with ownership, but without the direct operational or management responsibilities or overhead obligations. This means full access to the books, board seat representation and financial remuneration as a shareholder. MutualRx has created a full-service pharmacy benefit administrator (“PBA”) that brings best-in-class solutions in support of a plan’s members and drug benefit program.
Headquartered in Los Angeles, MutualRx’s seasoned pharmacy benefit executives have deep experience in the operational and management functions required to run a successful pharmacy benefit administration service. Everything from claims adjudication, billing & invoicing, network contracting, rebate management, formulary development, clinical management, I.T development, reporting, account management and call center member services are included and available to our client partners as a turn-key solution. This model empowers the drug benefit plan sponsor to get into the PBM business without the PBM!
The PBM model has been in place for 40+ years and has grown to serve PBM shareholders, while PBM clients have been forced to linger in a non-transparent world of undecipherable prescription drug transactions. PBM shareholders and Wall Street have loved that model's performance over the years. Clients and members, not so much!
MutualRx's vision makes your Plan and your members direct stakeholders. Technology has enabled us to bring your Plan customized benefit features, efficiencies that reduce costs and stellar member service. Our model applies a simple and straightforward administrative fee. Improved pricing through better discounts and rebates accrue to your members and your Plan. Any profitability is shared with our client equity partners.
Come grow with us!
Roy is a healthcare technology leader and entrepreneur who has been at the forefront of pharmacy benefit planning for over 30 years. He has been a Principal, Officer and Health & Welfare Practice Leader for the actuarial firms Milliman and The Segal Group. During his career, he has been the Founder and President of two healthcare benefit consulting and technology firms and created one of the first electronic prescribing applications for physician practices, helped develop an innovative wireless transport protocol, founded one of the first health insurance shopping and review companies, and was an early shareholder in a XML-based software company that was successfully acquired by Citrix. He has also served as Vice-Chairman of a leading national patient assistance program that provided free prescriptions medication to patients in need.
Andy is a chief technologist and inventor with very diverse and deep experience in AI, data mining, BI, and information architecture in biomedical, financial services, and web marketing. As an entrepreneur he has successfully built, mentored, and led R&D teams and companies based on AI and predictive modeling. He was first to develop and commercialize hybrid Artificial Intelligence (AI) predictive modeling combining data mining expertise in statistics, neural networks, genetic algorithms, fuzzy logic, semantic ontologies, and other advanced machine learning techniques. Andy has been the Founder and/or CTO of Neuristics, which enables merging credit data and scoring and is used by CreditXpert, the largest consumer credit company on the Web; Revelytix, a pioneer in semantic web technologies; and Infermetrics, a company that provided real-time web analytics and ad optimization engine for interactive online advertising.
Marco is an experienced developer and holds an MS in Computer Science. He is a full-stack engineer with a focus in Hyperledger Fabric. He is expert in blockchain technology, cloud computing, software architecture and technology development. Marco's projects have included building the entire infrastructure for client companies, including back end and front end design. His builds incorporate state-of-the-art security and authentication on top of the flow of the business data, including optimization of code and algorithms and design principles applied to the Mutual Rx model.
Marco has also led development teams where blockchain was applied to financial services to accelerate financial transactions. He also developed a transaction system to distribute payments of digital assets utilizing Hyperledger Fabric.
Gary is a physician who is an expert in the field of prescription drugs and specialty drugs. He has served as VP at Independence Blue Cross where he was responsible for the prescription drug benefits and specialty drugs for over 2 million members. He has also been a consultant to the Towers Watson Rx Collaborative where he chaired their P&T committee, served as Medical Director for the Patient Access Network Foundation, and is a Board member of the Academy of Managed Care Pharmacy (AMCP).
MutualRx has assembled all of the management and operational requirements for running your successful PBM. Our team consists of pharmacists, PharmD's, data scientists, account managers, and member Help Desk specialists.
We have all the operational bases covered: clinical, financial, legal and administrative. Your Plan can be up and running in no time! MutualRx has done it for you, so that your Plan and your members receive the benefits of ownership without the managerial or administrative distractions.
