Independent pass-through PBM · A PPOk company
Independent pharmacy benefit management · Since 2005
MaxCare is the independent PBM that puts your money back where it belongs: in your plan. No spread pricing. No conflicts of interest. Just the lowest net cost in pharmacy benefits, backed by clinical expertise and community care.
Savings you can see
Every dollar in drug discounts and manufacturer rebates flows to your plan, not our bottom line. MaxCare is paid through a single, all-in administrative fee, so you always know what you are paying for.
Why self-insured employers choose MaxCare
What is MaxCare Rx?MaxCare Rx is an independent, pass-through pharmacy benefit manager (PBM) in Oklahoma City that helps self-insured employers lower total pharmacy spend. Founded in 2005 and part of the PPOk family, it passes through 100% of drug discounts and manufacturer rebates, charges zero spread pricing and is paid one transparent administrative fee.
The traditional PBM model has a problem: most PBMs make money on spread pricing, charging your plan more than they pay the pharmacy and keeping the difference. They earn rebates from drug manufacturers and share only a fraction with you. The incentives are misaligned.
MaxCare was built differently. With no ties to an insurer, mail-order pharmacy or specialty drug company, we have one goal: reduce your total pharmacy spend at the source. Our success is measured by your savings, and we will prove it on paper.
Learn how pass-through pricing works| Traditional PBM | MaxCare |
|---|---|
| Traditional PBMs keep the spread between what you pay and what the pharmacy receives. | MaxCare charges zero spread. You pay what the pharmacy is paid. |
| Traditional PBMs share only a fraction of rebates. | MaxCare passes through 100% of manufacturer rebates. |
| Traditional PBMs steer members to pharmacies they own. | MaxCare is fully independent: no insurer, no mail-order pharmacy, no conflicts. |
| Traditional PBMs bury fees across spread pricing, retained rebates and charges you never see. | MaxCare charges one transparent, all-in administrative fee, so you always know what you are paying for. |
For self-insured employers and the brokers who represent them, that difference is worth millions.
What MaxCare delivers
Every part of the model points the same way: toward a lower total pharmacy spend for your plan and better care for your members.
Lowest net cost is a contractual commitment at MaxCare, not a marketing phrase. We pass through 100% of drug discounts and 100% of rebates to your plan, and our clinical programs target the highest-cost categories where most PBMs leave money on the table.
MaxCare is not owned by an insurance company, mail-order pharmacy or specialty drug distributor. Every clinical recommendation, formulary decision and vendor relationship is made for one priority: what is best for your plan and your members. Our pay is one administrative fee you can see, evaluate and budget for.
Contracts alone cannot control pharmacy cost. Our clinical team manages your highest-cost claims before they become budget problems: specialty utilization review, GLP-1 oversight, biosimilar transitions, rare disease management and concurrent and retrospective DUR.
Big-box PBMs push members toward the mail-order and specialty pharmacies they own. MaxCare supports independent and regional pharmacies that employ local staff and know members by name. For dispersed and rural workforces, that access is essential.
Clinical programs
Eleven targeted programs that manage pharmacy spend where it grows fastest.
Capture manufacturer assistance programs to reduce member and plan cost.
Redirect high-cost specialty claims to lower-cost alternatives.
Accelerate biosimilar adoption with clinical and formulary guidance.
Identify cost-driving patterns before claims compound.
Specialized oversight for ultra-high-cost rare condition therapies.
Move infusion therapies from hospital outpatient to lower-cost settings.
Clinical protocols for the fastest-growing category in pharmacy spend.
Drug utilization review that catches problems in real time and over time.
Improve member outcomes and reduce total plan cost through adherence support.
Save 25–55% off AWP for eligible members through community-based 340B pharmacies.
Capture untapped rebates on 110+ injectable medications spanning 1,750 unique NDCs.
Medical rebate management
Manufacturers offer rebates on medical claims that go untapped, because few organizations have the expertise or qualifications to submit claims and collect incentive funds on specialty drugs billed under the medical benefit.
MaxCare captures rebates currently offered on more than 110 injectable medications spanning 1,750 unique NDCs. It is a direct cost offset for your plan, with no added administrative burden. For brokers and TPAs, it is also a differentiator and a potential new revenue stream.
36%of specialty drug spend appeared on medical claims in 2023, outside the reach of a standard pharmacy benefit.
We handle negotiating, qualifying, submitting and tracking, so you don’t have to.
Purpose-built technology captures every eligible rebate, including those frequently overlooked.
Detailed reports down to the NDC level give you full visibility into rebate earnings.
Clear insights and analytics uncover new rebate opportunities.
Discover the MaxCare advantage
We take a consultative approach, partnering with employers to manage their pharmacy benefit: proactive, tailored and built to control prescription costs.
Who we serve
For benefits brokers
For self-insured employers
What our partners say
From groups as small as 100 members to as large as 10,000: effective solutions, easy-to-understand plans and contracts that keep members in focus.
How our partners manage their pharmacy benefits with MaxCare (video on YouTube, opens in a new tab)Employer guides
An independent pharmacy benefit manager (PBM) can give an employer a clearer path to aligned decision-making, but independence alone is not proof…
Most self-insured employers know their pharmacy benefit costs are high. Fewer know exactly why, or where the money is going. Spread pricing is one…
Most employers know pharmacy benefits are expensive. Fewer can see exactly where the money goes after a prescription claim is processed, a rebate…
Frequently asked questions
Plain-language answers, the way pharmacy benefits should be explained.
All FAQs for brokers, employers and membersMaxCare 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.
About MaxCare
MaxCare was founded on a simple belief: pharmacy benefit management works better when the PBM is on the same side as the employer. We are independent. We are transparent. And we are committed to the employers, brokers and members we serve, including the community pharmacies that have served them for generations.
Get a no-obligation pharmacy spend analysis and see what MaxCare could save your organization, in plain language and backed by data.
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