What We Offer

Services Built for the
Modern PBM Landscape

From claims adjudication to real-time analytics, every SRxS service is designed to be fully configurable, scalable, and delivered at a cost that works for organizations of every size.

Claims & Adjudication Network & Payment Rebate Management Formulary & Plan Design Discount & Copay Programs Data & Analytics
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Real-Time, Rules-Driven Claims Processing

Our adjudication engine is built to handle virtually any business rule — at any scale. Fully configurable, fully transparent, and built for speed.

Claims Adjudication Platform

A modern, cloud-native adjudication engine that processes pharmacy claims in real time with pinpoint accuracy.

  • Configurable business rules engine — apply virtually any clinical, financial, or operational rule
  • Real-time claim processing with sub-second response times
  • Support for retail, mail-order, specialty, and long-term care claims
  • NCPDP-compliant transaction processing
  • Reject and override management with audit trails

Workers' Compensation Pharmacy

Specialized adjudication logic purpose-built for the unique billing and regulatory requirements of Workers' Comp pharmacy programs.

  • State-specific fee schedule integration
  • Injury and diagnosis code validation
  • Controlled substance monitoring and reporting
  • Coordination with medical bill review workflows
  • Employer and adjuster-level reporting

Hospice Pharmacy Adjudication

Adjudication configured for the sensitivity and clinical complexity of hospice and end-of-life pharmacy care.

  • Formulary rules aligned with comfort-focused care protocols
  • Diagnosis and eligibility validation for hospice beneficiaries
  • Seamless coordination with Medicare Part A billing
  • Palliative care drug list management
  • Provider and facility-level reporting

Customized Payment Administration

Flexible, client-configured pharmacy payment workflows that reduce administrative burden and eliminate payment errors.

  • Custom payment cycles and disbursement schedules
  • Multi-payer and multi-plan payment routing
  • Automated reconciliation and exception handling
  • Electronic remittance and explanation of benefits (EOB)
  • Tailored invoicing tied to client billing structures

Any Rule. Any Plan. Any Scale.

Our adjudication platform applies virtually any business rule — clinical edits, coverage restrictions, step therapy, quantity limits, prior authorization, and more — without requiring custom development. Configuration is handled through our intuitive rules management interface.

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Nationwide Access. Seamless Administration.

SRxS connects clients to a broad pharmacy network while delivering the payment infrastructure to manage it all efficiently.

Nationwide Pharmacy Network Rental

Instant access to a comprehensive national pharmacy network — without the overhead of building or owning one.

  • Access to 60,000+ retail pharmacy locations nationwide
  • Specialty, mail-order, and long-term care network options
  • Competitive network pricing and reimbursement rates
  • Network performance monitoring and reporting
  • Custom network configurations by geography or plan type

Network Design & Optimization

Strategic pharmacy network architecture tailored to your member population, cost targets, and clinical goals.

  • Preferred, standard, and limited network configurations
  • Geographic access analysis and gap identification
  • Tiered network design for cost management
  • Mail-order and specialty channel integration
  • Network adequacy reporting for regulatory compliance

MAC Pricing Management

Maximum Allowable Cost (MAC) pricing administration to control generic drug spend and ensure competitive reimbursement.

  • Custom MAC list creation and maintenance
  • Automated MAC price updates and market alignment
  • MAC appeal management and adjudication integration
  • Transparent pricing analytics and benchmarking
  • State-specific MAC compliance management

Tailored Invoicing Services

Client-specific invoicing designed around your billing structure, payment terms, and reporting requirements.

  • Flexible invoice frequency — weekly, bi-weekly, or monthly
  • Plan, group, and member-level billing breakdowns
  • Automated invoice generation and delivery
  • Integrated payment reconciliation and aging reports
  • Custom invoice formatting and branding options
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Maximizing Manufacturer Value. End to End.

SRxS manages the full rebate lifecycle — from contracting and tracking to reconciliation and client distribution — with full transparency at every step.

Rebate Administration

Comprehensive rebate management that captures every eligible dollar owed and ensures accurate, timely distribution.

  • Manufacturer rebate contract management and tracking
  • Automated rebate calculation and accrual reporting
  • Claim-level rebate eligibility validation
  • Rebate payment processing and reconciliation
  • Client-level rebate pass-through reporting

Rebate Contracting Support

Expert guidance on structuring manufacturer rebate agreements to maximize return across your formulary.

  • Market share and performance-based rebate structuring
  • Formulary position strategy and tier placement analysis
  • Supplemental rebate program management
  • Rebate forecast modeling and scenario analysis
  • Audit-ready documentation and reporting
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Full Transparency. Zero Guesswork.

Every rebate dollar is tracked, reported, and reconciled with complete visibility. Our clients see exactly what was earned, what was received, and what was passed through — with no black boxes and no buried fees.

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Configurable Plans. Clinically Sound Formularies.

Build benefit structures and drug lists that align with your clinical philosophy, cost targets, and member population — all managed through one platform.

Formulary Management

Dynamic formulary tools that keep your drug list current, clinically appropriate, and optimized for cost and quality.

  • Tier-based formulary construction and maintenance
  • Clinical edit management — PA, step therapy, quantity limits
  • Formulary exception and override processing
  • Drug utilization review (DUR) integration
  • Regulatory and compliance monitoring

Plan & Benefit Design Management

Fully configurable plan architecture supporting any benefit structure, member segment, or program type.

  • Copay, coinsurance, and deductible configuration
  • Multi-tier and multi-group plan support
  • Accumulator and out-of-pocket maximum management
  • Specialty and high-cost drug benefit carve-outs
  • Medicare, Medicaid, commercial, and self-funded plan support
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Reducing Member Costs at the Point of Sale.

SRxS powers pharmacy discount and copay assistance programs that deliver immediate savings to members — with the infrastructure to scale them nationally.

Pharmacy Discount Card Programs

End-to-end discount card program administration — from card issuance and branding to real-time adjudication and reporting.

  • Custom-branded discount card design and fulfillment
  • Real-time adjudication at point of sale
  • Access to negotiated rates across our nationwide network
  • Digital and physical card delivery options
  • Member utilization and savings reporting

Copay & Coupon Assistance Management

Pharmacy manufacturer copay card and patient assistance program administration — reducing financial barriers for members.

  • Manufacturer copay card integration and adjudication
  • Patient assistance program (PAP) enrollment support
  • Specialty drug copay accumulator management
  • Maximizer program administration
  • Member-facing savings reporting and EOB coordination
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Get Your Pharmacy Discount Card Today

SRxS discount cards provide access to negotiated prescription pricing at thousands of pharmacies nationwide — at no cost to the member. Savings are applied instantly at the point of sale.

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Real-Time Intelligence. Actionable Insights.

Our data infrastructure gives clients live visibility into claims, utilization, costs, and performance — with the tools to act on what they see.

Advanced Data Reporting & Analytics

Comprehensive reporting dashboards that surface the right data at the right time — from executive summaries to claim-level detail.

  • Configurable dashboards by role, plan, or group
  • Drug utilization, trend, and cost analysis
  • Member adherence and outcomes reporting
  • Formulary and network performance metrics
  • Scheduled and on-demand report delivery

Real-Time Data Access via API Library

A comprehensive REST API library providing live, secure access to claims, eligibility, member, and benefit data.

  • RESTful API with real-time claim and eligibility data
  • Secure OAuth 2.0 authentication
  • Pre-built integrations for common health IT systems
  • Sandbox environment for testing and development
  • Full API documentation and developer support

Automated Data Transformation Toolkit

Eliminate manual data handling with automated ingestion, mapping, and transformation from any source format.

  • Support for NCPDP, HL7, EDI, and custom file formats
  • Automated eligibility file loading and validation
  • Custom data mapping and field transformation
  • Error detection, alerting, and exception management
  • Scheduled and event-driven data pipeline execution

Surescripts F&B and RTPB Integration

Certified integration with Surescripts' Formulary & Benefit (F&B) and Real-Time Prescription Benefit (RTPB) services — delivering accurate, real-time drug cost and coverage information directly to prescribers at the point of care.

  • Surescripts Formulary & Benefit (F&B) data transmission to prescribers and EHRs
  • Real-Time Prescription Benefit (RTPB) integration for live patient cost transparency
  • Accurate member-specific cost-sharing displayed at point of prescribing
  • Formulary status, tier, and coverage restriction data delivered in real time
  • Supports prescriber-driven therapeutic alternatives and lower-cost options
  • Reduces prescription abandonment by surfacing accurate out-of-pocket costs upfront

Ready to put these
services to work?

Every SRxS service is fully configurable to your organization's needs. Let's talk about building the right solution for you.