Health Plans

Rely on Elixir for the control and flexibility you need

Why Elixir is the Right PBM Partner for Health Plans

Elixir isn’t your typical pharmacy benefit management (PBM) company… In fact, we’re working very hard to be not just different than the rest, but better. Here's How

Scale & Flexibility: Large enough to compete and flexible enough to deliver on client requirements

Retail, mail and specialty pharmacy services. We are part of Rite Aid, a Fortune 200 company, which not only gives us the strength to compete aggressively on discounts, rebates and anciliary fees, it also creates enterprise-wide pharmacy services. This means over 2,000 retail stores in 17 states and over 6,300 pharmacists corporate-wide who deliver multiple opportunities for a high-touch member experience throughout the pharmacy value chain, through counseling in our specialty and mail facilities, virtual online chat, in a retail setting or in our call centers.

One of the largest PBMs providing Medicare services not owned by a health plan payer. Elixir is the only PBM owned by a retail pharmacy that is independent of a health plan payer, ensuring alignment with your goals. We know Medicare and ensure data privacy. We manage 500,000+ Medicare lives and we own and operate one of the largest Medicare Part D plan in the nation. With Elixir, you don’t have to wonder about a conflict of interest, because we are not competing against you.

Medicaid, Medicare, Exchange and Commercial management under one roof. We understand the needs and market trends of each type of health plan and are able to support your growth, offering sales, proposal, underwriting and marketing support. We’ve seen a 232% membership growth over a three-year period for our start-up health plan clients. Aligning with your goals, we are willing to comply with RFP requirements that many others aren’t flexible enough to even consider.

Transparent data steward. Transparency isn’t just a pricing option with us. It means contract language that’s easy to understand, with straightforward definitions and exclusions, and you have full data rights. We provide you with ALL of your data because it belongs to you.

Industry Knowledge & Expertise: Pharmacy benefits veterans recognized as a top 10 PBM1

Over 15 years supporting health plan clients and government programs. We’re not new to pharmacy benefits or Medicare—in fact, we have been a direct CMS contractor since 2007. When we were founded over 20 years ago, we were a pioneer in rebate transparency and the first to provide point-of-sale rebates. Over the past two decades, we’ve helped health plans understand the trends, grow their membership and create solutions unique to their populations.

Full pharmacy care experience. As a full-service PBM, we have been purposely built and own all the assets needed to give your pharmacy program control, stability, scale and privacy:

  • Industry leading adjudication platform, offering flexibility, efficiency and data privacy protection
  • Accredited mail and specialty pharmacies, creating an exceptional member experience, waste reduction and cost savings
  • Population health services through our sister company, Health Dialog
  • Prescription discount programs for uninsured and under-insured and Medicare Part D plans for individuals, associations and groups

More quality accreditations than most PBMs. As a provider of healthcare services, you know how important quality is to all. Elixir is one of only two PBMs to earn all four core PBM accreditations by URAC. We are one of only three PBMs to earn NCQA Health Information Products Certification for Pharmacy Benefit Information, and hold many other quality accreditations.

Consultative & Trusted Advisor: Our real strength is our people.

Dedicated health plan teams. Elixir has over 1,500 associates—true pharmacy professionals—who work toward our mission of helping achieve whole health for life. With hundreds of years of combined healthcare experience with health plans, a dedicated account team puts their expertise to work for you. This means those you work with are well versed in the challenges you face every day and offer solutions that work.

All groups, no matter the size, are supported by a dedicated account executive, account manager and clinical account executive, who meet with you regularly for ongoing alignment, strategy and interventions to drive goals. Our Medicare clients also work with a dedicated compliance officer who works directly with your teams to stay current on local, state and federal regulations. Our clients have rated our responsive account teams with a 99% client satisfaction rate.

Team of dedicated Medicare Part D experts. Our team of subject matter experts manage all delegated services and support strategic plan initiatives to ensure compliance, increase Star ratings, grow membership and deliver great service to both plan administrators and covered members. We act as an extension of your team, actively supporting you through CMS audits, protecting you from fraud, waste and abuse through our analytics, and ensuring benefits are adjudicating correctly.

Facilitator of value-added clinical services. Elixir has the resources, expertise and willingness to customize its clinical support for the unique needs of each health plan client, including:

  • Proactive management of benefits and formularies, specific to your needs
  • Opioid Safety program that complies with CMS requirements for a Drug Management Program
  • Medication Therapy Management (MTM) program and Comprehensive Medication Reviews, which support closing care gaps and increasing adherence
  • Stars Adherence program, a data-driven care management program targeting at-risk members with diabetes, hypertension and high cholesterol

Industry leading specialty solutions. With specialty approaching 50% of drug spend, Elixir has created industry leading specialty solutions, which include our own specialty pharmacy, a best-in-class network, access to limited distribution drugs, and a unique and proven process for working with alternative payers.

Most importantly, we spend the necessary time per member assessing and closing gaps in care, enabling behavioral change and improving health outcomes. Proving that our specialty care management works, we have achieved a Net Promoter Score (NPS) of 82, which is eight points higher than the national average.*


* NPS is one of the most used satisfaction indicators in all industries, based on one question, “would you refer Elixir Specialty to someone else?”