Who Runs the Drug Programs Related to Rx Carveouts?

Self Fund Health does not outsource drug carveout management to fragmented vendors. We manage these programs in partnership with CapitalRx, our pharmacy benefit manager, and our nurse navigation team.

•CapitalRx provides the backbone: transparent pricing, rebate clarity, and access to specialty channels that allow us to source high-cost drugs (including infusion medications) at lower prices.

•Nurse Navigators work directly with members and prescribers to coordinate care, ensure safety, and guide people to the most cost-effective options.

•Technology Integration ties it together—our system flags high-cost medications in real time so we can intervene before spend occurs.

•Example: CanaRx – For certain high-cost specialty medications, we use CanaRx’s international sourcing program. This allows members to receive their medication at no cost while employers avoid inflated U.S. pricing.

The result: drug programs are run as a fully integrated part of the health plan. Outside carveout vendors disrupt this alignment and reduce savings.