Fix the Drugs Driving Your Spend
Without Replacing Your PBM or TPA
ApalyRx is a prescription routing and benefit operations platform that helps employers and health plans access manufacturer-direct, lowest net-cost drugs by operationalizing targeted carve-out programs alongside their PBM - with real-time independent routing, transparent economics, and decision-level documentation for every script.
Request a ConversationWhy Employers Are Frustrated
The traditional model is broken. Here's what benefit managers face every day.
Opaque Pricing
Rebate structures are completely opaque - you never know your true net cost until months later, if ever. No independent party verifies that each prescription reached the lowest available price.
Loss of Control
Formulary choices are often shaped by contracts outside your control - reducing transparency and limiting your options on high-cost drugs. The entity making routing decisions has financial relationships with the dispensing channels being evaluated.
Limited Access to Best Pricing
You can’t access manufacturer-direct pricing or direct-to-consumer rates - those programs sit outside PBM adjudication, invisible to your benefit. Billions in manufacturer value goes unrecognized.
Poor Member Experience
Members want clarity and momentum - clear expectations, timely updates, and fewer steps between prescription and delivery. Instead they navigate a fragmented system with no coordination.
💸 Result: Overpaying by 20-40% on your highest-cost drugs, no independent proof of optimal routing, and unhappy plan members.
What You Get With ApalyRx
A modern approach that puts you back in the driver's seat
Lower Your Pharmacy Spend
Access Direct, Net Preferred Pricing
ApalyRx focuses on the highest-impact medications - often approximately 30 drugs that represent 40-50% of pharmacy spend. Every prescription independently routed to the lowest net cost across all available channels.
Control Your Program Rules
Define Every Aspect of Your Program
Define cost share, PA/UM, eligibility, and allowed fulfillment channels program by program. Every rule you set is applied in real time and documented in the decision record for every script.
Keep Your Current Infrastructure
No PBM or TPA Rip-and-Replace
ApalyRx works alongside your PBM and TPA - carved-out drugs run through ApalyRx with independent routing and documentation; everything else stays in your existing pharmacy benefit flow.
Future-Proof Drug Routing
Automatic Adaptation
As new drugs, biosimilars, and lower-cost alternatives emerge, ApalyRx automatically adapts routing through your existing connection - evaluating all channels in real time, no additional integration needed.
Same infrastructure. Independent routing. Decision-level proof. Zero disruption.
How ApalyRx Works
Select Your Drugs
You select the drugs to include in your programs (e.g., GLP-1s, specialty medications, other high-cost drugs driving your spend)
Define Program Rules
You define program rules: member cost share, PA/UM criteria, allowed fulfillment channels, eligibility requirements. Your rules, your control.
Members Create Accounts
Members create their account and direct prescribers to send scripts to ApalyRx for in-scope medications
Eligibility Validation
ApalyRx validates member eligibility and applies your program rules in real time - PA requirements, cost-share calculations, and channel controls
Independent Routing to Lowest Net Cost
Every in-scope prescription is evaluated across all available channels - PBM specialty, PBM mail, retail, manufacturer-direct, and independent pharmacy - and routed in real time to the lowest net cost
Collection & Settlement
ApalyRx collects member cost share, reports to accumulators, submits charges as medical claims to your TPA, and settles with suppliers via ACH - closed-loop financial reconciliation
Delivery, Support & Documentation
Medication ships to member’s home with concierge support. Every prescription generates a decision-level record - channels compared, rules applied, routing rationale, and net cost components. Audit-ready by default.
Complete Platform Capabilities
Everything you need to run high-cost drug programs, built in
One platform. Complete control. Independent proof. Enterprise-ready.
Implementation Timeline
A structured path from contract to live program
Contract & Design
Program scope, rules, pricing, and integration plan
Integration
TPA connection, eligibility feeds, accumulator setup
Testing
End-to-end validation with real data
Go-Live
Member enrollment and first prescriptions routed
Optimize
Expand drug scope, refine rules, add programs
Existing TPAs can go live in as little as 30 days
“We carved out our top GLP-1 and specialty drugs through ApalyRx. The savings were immediate, the documentation was better than anything our PBM provided, and our members had zero complaints about the experience.”
- Benefits Director, Self-Funded Employer
GLP-1 Cost Reduction
Employees Covered
Annual Savings
Zero member complaints. Concierge support. Medications delivered to their door.
Frequently Asked Questions
ApalyRx is a prescription routing and benefit operations platform that helps employers and health plans access manufacturer-direct, lowest net-cost drugs by operationalizing targeted carve-out programs alongside their PBM. We provide real-time independent routing, transparent economics, and decision-level documentation for every script.
Yes. Claim files can show ‘net’ costs differently depending on rebate timing, guarantees, and fee allocations. We provide an all-in comparison based on reconciled data. More importantly, ApalyRx provides independent, decision-level documentation for every prescription - showing which channels were evaluated and why the winning channel was selected. If your current routing is already optimal, the documentation proves it. If it is not, the savings speak for themselves.
When a prescriber sends an e-prescription for an in-scope medication, ApalyRx evaluates it across all available channels in real time - PBM specialty, PBM mail, retail, manufacturer-direct, and independent pharmacy. The platform applies your program rules (cost share, PA/UM, channel controls) and routes to the lowest net cost. Every decision is documented with a complete audit trail.
ApalyRx focuses on the highest-impact medications - typically approximately 30 high-cost drugs that represent 40-50% of employer pharmacy spend. These are the drugs where net cost varies most across channels and where optimized routing has the greatest financial impact. The platform extends to additional therapeutic categories as your program evolves.
Members create an account on the ApalyRx platform and direct their prescribers to send in-scope prescriptions to ApalyRx. From there, the platform handles everything - eligibility validation, routing, fulfillment coordination, and concierge support. Medications ship directly to the member’s home with real-time status updates and a dedicated support team.
ApalyRx collects member cost share at the point of service and reports to plan accumulators. The plan portion is submitted either as a medical claim to your TPA or pharmacy claims to your PBM (depending on your specific configuration) for data continuity. Suppliers are paid via ACH with transparent, pass-through economics - no spread, no markup. Every transaction is reconciled in the decision-level record.
Every prescription generates a decision-level record showing which channels were evaluated, what rules were applied, the routing rationale, and net cost components. You also get reporting dashboards with program-level analytics, cost trends, and utilization data. All documentation is audit-ready by default.
Implementation follows a structured timeline: program design, TPA integration, testing, go-live, and optimization. Existing TPAs can go live in as little as 30 days. The timeline varies based on program complexity and integration requirements.
ApalyRx operates independently of your PBM and TPA. If you switch either one, your ApalyRx carve-out programs continue to run - we simply connect to your new TPA for claims submission and accumulator reporting. Your program rules, pricing, and documentation history are unaffected.
ApalyRx does not require replacing your PBM. We implement carved-out programs with a clear scope and documentation so your PBM can continue managing the remainder of the pharmacy benefit. We support a structured review of relevant contract provisions and coordinate implementation steps to keep the program compliant. Many PBMs are choosing to offer ApalyRx as part of their own program - independent routing strengthens their client relationships rather than conflicting with them.
Yes. ApalyRx is a pharmacy-licensed operator with no ownership in any dispensing channel. This structural independence ensures that routing decisions are made solely based on lowest net cost - the evaluation has no financial interest in the outcome.
Drug Benefit Integrity (DBI) is an independent industry standard with five structural requirements for ensuring pharmacy benefit decisions are made in the plan’s interest. ApalyRx is the only entity that meets all five requirements - real-time all-channel routing, pharmacy-licensed operator with no channel ownership, manufacturer-direct programs built into the benefit, independent pharmacy fulfillment, and decision-level records for every script. Learn more at drugbenefitintegrity.com.
Yes. The Consolidated Appropriations Act of 2026 designates PBMs as ERISA covered service providers with significant noncompliance penalties. Plan fiduciaries face personal liability for drug benefit decisions. ApalyRx produces decision-level documentation for every in-scope prescription - showing which channels were evaluated, what rules were applied, and why the winning channel was selected. This provides fiduciary-grade proof that can be presented to auditors, regulators, and beneficiaries.
Ready to Take Control of Your High-Cost Drug Spend?
We'll propose a carve-out program design that fits your plan - with real savings projections based on your population, independent routing across all channels, and decision-level documentation for every script.
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