Manufacturer-Direct Drug Pricing Inside Your Benefit
ApalyRx operates alongside your existing PBM and TPA. Carve out the high-cost drugs where manufacturer-direct pricing has the greatest impact. Nothing changes except the cost, and every routing decision comes with decision-level documentation your plan can defend.
Schedule a BriefingOverpaying on High-Cost Drugs with No Way to Verify
Self-funded employers bear the direct cost of their members' drug spend. Under ERISA, plan fiduciaries face personal liability for those decisions. The Consolidated Appropriations Act now designates PBMs as covered service providers with significant noncompliance penalties. Yet most employers have no independent way to verify that each high-cost prescription was fulfilled at the lowest available net cost, or to document why any given fulfillment decision was made.
The entity making fulfillment decisions has financial relationships with the dispensing channels being evaluated. There is no independent verification layer.
Manufacturer-direct pricing programs, often the lowest net cost option for high-cost specialty drugs, sit outside PBM adjudication entirely. They are invisible to the benefit. Employers cannot access what they cannot see, and cannot document what they never evaluated.
overpay on high-cost drugs vs. manufacturer-direct pricing
independent routing records in standard PBM-administered benefit
fiduciary liability for plan decisions under ERISA
Configure, Route, Settle
Configure
Select the high-cost drugs driving your spend. Define program rules: member cost share, prior authorization criteria, allowed fulfillment channels, and eligibility requirements. Your rules, your control. The platform is configured and ready to receive prescriptions through the standard e-prescribing workflow.
Route
Until now, every prescription was fulfilled through a predetermined channel with no per-prescription evaluation. ApalyRx changes that. Every in-scope prescription is evaluated across all available supply channels in real time: manufacturer-direct programs, retail pharmacy, mail order, and independent pharmacy. The platform applies your program rules and routes to the lowest net cost channel for that specific prescription. Every decision is documented with the channels compared, the rules applied, and the routing rationale.
Settle
Collect member cost share and report to plan accumulators. Bill plan portion through claims for data continuity. Pay suppliers via ACH with transparent, pass-through economics. Every prescription generates a decision-level record: channels compared, rules applied, routing rationale, net cost components.
Five Structural Advantages
Independent
No ownership in any dispensing channel. Routing decisions are structurally independent. The evaluation has no financial interest in the outcome.
Real-Time
Every prescription routed at the point of decision, not sampled retrospectively, not reported after the fact. Real-time all-channel evaluation.
Documented
Decision-level records for every script: channels compared, rules applied, routing rationale, and closed-loop financial reconciliation.
Compatible
Works alongside your existing PBM and TPA. Carve out only the high-cost drugs where routing optimization has the greatest impact.
Manufacturer-Ready
Infrastructure for manufacturer direct-to-employer programs: eRx intake, eligibility, billing, settlement, and accumulator reporting built in.
Built on the Drug Benefit Integrity Standard
Drug Benefit Integrity (DBI) is an independent industry standard with five structural requirements for ensuring that pharmacy benefit decisions are made in the plan's interest. ApalyRx meets all five.
ApalyRx is the only entity that meets all five requirements.
Learn more about the DBI standard →Let's Define Your Key Problem Drugs.
Tell us which drug categories are driving your costs. We will show you how ApalyRx routes those prescriptions to the lowest net cost alongside your existing PBM and TPA, with decision-level documentation for every script and real savings projections based on your population.