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Capital Rx PBM

Improved quality and experience expected for members

Effective January 1, 2023, Capital Rx will become the new pharmacy benefit manager (PBM) for CDPHP.


What is a PBM?

Pharmacy benefit managers, or PBMs, manage prescription drug benefits on behalf of health insurers. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant behind-the-scenes impact in determining the costs of prescription medications for insurers, and ultimately patients.


What does this mean for members?

We fully expect our members and business partners to experience an improved quality and experience of care as a result of this decision. This decision does not apply to all CDPHP members as not all employer groups have their pharmacy benefit through CDPHP.


What do you know about Capital Rx?

With more than 150 clients covering more than one million lives, Capital Rx is one of the fastest growing health care companies in America and offers game-changing technology in both claims processing and benefit configuration.

By partnering with Capital Rx, CDPHP aims to stem the tide of rising drug prices through greater price transparency, as well as a new pricing model that more accurately and fairly sets the cost of drugs. We are proud to say that Capital Rx sets its prices with full transparency using actual unit drug costs based on the National Average Drug Acquisition Cost (NADAC), which is maintained by the Centers for Medicare and Medicare Services (CMS).  

Additionally, Capital Rx is more agile than any other PBM on the market. It can modify formularies in days rather than weeks or months, allowing CDPHP to seamlessly update our list of covered drugs. As new, more affordable drugs come to market, CDPHP will be able offer those products more quickly to our members.