FAQs

MaxCare is an independent pharmacy benefit manager (PBM) based in Oklahoma City that helps self-insured employers reduce total pharmacy spend. MaxCare passes through 100% of drug discounts and manufacturer rebates, charges zero spread pricing, and manages high-cost claims with dedicated clinical programs.

Unlike traditional PBMs, MaxCare is not owned by an insurance company, mail-order pharmacy or specialty drug distributor. That independence removes the conflicts of interest that drive up costs: no spread pricing, no retained rebates and no steering members to PBM-owned pharmacies.

MaxCare reduces costs at the source: 100% pass-through of discounts and rebates, plus clinical programs that target the highest-cost categories, including specialty coupon management, biosimilar adoption, site-of-care optimization, GLP-1 management and 340B access that saves eligible members 25–55% off AWP.

Pass-through pricing means the plan pays exactly what the pharmacy is paid, the PBM keeps no spread, and every manufacturer rebate flows back to the plan. It is the pricing model that aligns the PBM’s incentives with the employer’s.

MaxCare charges a single, flat, all-in administrative fee, disclosed up front and kept separate from your drug costs. It does not rise and fall with your drug spend, and there is no spread pricing or retained rebate layered underneath it, so you can evaluate your true pharmacy cost and plan your benefit spend with confidence.

Yes. MaxCare supports the community pharmacy network: independent and regional pharmacies that know members by name. For employers with dispersed workforces and rural members, that access is essential, and MaxCare’s network keeps it open.

Eleven targeted programs: specialty coupon management, high-dollar exclusion, biosimilar management, proactive utilization management, rare disease drug management, site-of-care optimization, GLP-1 and weight loss management, concurrent and retrospective DUR, adherence management, 340B program access and medical rebate management.

In 2023, 36% of specialty drug spend appeared on medical claims, where manufacturer rebates typically go uncollected because few organizations are qualified to submit them. MaxCare’s Medical Rebate Management captures rebates on more than 110 injectable medications spanning 1,750 unique NDCs and manages negotiation, qualification, submission and tracking end to end, with payment and forecast reporting down to the NDC level.

MaxCare has managed pharmacy benefits for employers since 2005 and is part of PPOk, founded by independent pharmacists in 1985. It pairs that experience with transparent, pass-through pricing and personalized service, so brokers can confidently offer cost-effective, compliant pharmacy benefit solutions.

We use data analytics, strategic formulary management and direct manufacturer negotiations to keep pricing competitive, helping clients achieve measurable savings without sacrificing care quality.

MaxCare designs flexible plans tailored to each client’s needs, from formulary options to specialty drug management, so brokers can present highly personalized benefits.

Onboarding is streamlined, with dedicated support teams, clear communication and minimal disruption, for a smooth transition for brokers and their clients.

MaxCare applies proven cost-containment strategies such as formulary optimization, generic substitution programs and member affordability initiatives that lower overall drug spend, on top of 100% pass-through of discounts and rebates.

We prioritize a smooth implementation with comprehensive member communication and dedicated support, minimizing disruption and easing the administrative workload.

Yes. Our pharmacy benefit plans adapt to different workforce demographics, health conditions and budget goals.

Employers receive clear, regular reports with actionable insights on drug utilization, cost trends and savings opportunities, plus 24/7 access to plan performance, drug pricing, pharmacy utilization and member trends through our analytics platform.

MaxCare strictly follows HIPAA and all regulatory standards and uses robust data security practices to protect member information.

Members can check the online formulary and benefit information in the member portal at my.maxcarerx.com to see medication coverage and estimate copays or out-of-pocket costs.

Our member support team is available by phone, email and online portal to help with benefits, claims and prescription questions. Call (800) 259-7765.

Yes. We maintain strict security protocols and comply fully with HIPAA to keep your personal and health data confidential and secure.