Capital Rx Expands Transparency Model to Specialty and Mail Prescriptions

Capital Rx, launched in 2018, is gaining traction in its effort to redefine the way prescriptions are priced and administered in the U.S. Capital Rx is a next generation pharmacy benefit manager (PBM), overseeing prescription benefit plans on behalf of employers, unions, and members.

Through its Clearinghouse Model, Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes.

Capital Rx is attempting to suppress “spread pricing” — a practice that occurs when health plans contract with PBMs to manage their prescription drug benefits, and PBMs keep a portion of the amount paid to them by the health plans for prescription drugs instead of passing the full payments on to pharmacies.

Capital Rx works to increase cost transparency and consistency for its clients by using the government-maintained National Average Drug Acquisition Cost database, which aims to provide accurate, upfront costs of drugs across pharmacies to health plans.

Recently, Capital Rx joined with Walmart to bring greater transparency to specialty and mail-order prescriptions. Joining up with Walmart, an early client, makes Capital Rx the first to offer that price transparency across retail, specialty and mail-order medications.

Earlier this year, Capital Rx appointed Matthew Gibbs, PharmD, as President of Commercial Markets. In this role, Mr. Gibbs will expand Capital Rx’s capacity to bring forward more accurate and efficient drug pricing methodologies to increase access, affordability and disclosure of medication costs to plan sponsors and members. Mr. Gibbs was most recently Aon’s Senior Vice President.


Takeaway: Capital Rx’s approach to bring greater transparency to drug pricing is gaining a foothold in the PBM market