PlaidRx Information

A small number of high-cost brand and specialty medications can account for a substantial share of a health plan’s pharmacy spending. For employers and Taft-Hartley health and welfare funds, addressing those costs is an opportunity to protect plan resources while supporting members who depend on ongoing treatment. PlaidRx is a voluntary, member opt-in pharmacy savings overlay that works alongside a plan’s existing PBM. Through more cost-effective medication sourcing and transparent, acquisition-based pricing, we help plans lower spending on select brand and specialty maintenance medications. Pricing is established upfront, and savings opportunities are evaluated net of applicable rebates and in the context of each plan’s existing contractual arrangements. Participating members receive medications through the program at no out-of-pocket cost. Our team coordinates outreach, enrollment, prescriber communication, and prescription delivery while preserving existing clinical controls and prescriber relationships. Members who do not enroll continue using their existing pharmacy benefit. We work with fund administrators, consultants, and advisers to identify savings opportunities and support implementation. Clinical areas of focus include autoimmune conditions, inflammatory bowel disease, oncology, multiple sclerosis, HIV, respiratory conditions, and hematologic disorders.