Pharmacy benefit analysis · Self-funded plans

Self-funded plans pay full price. We find where they don't have to.

You carry every pharmacy claim directly: no insurer buffer, no pooled risk. StreamRX shows you where your drug spend has lower-cost options, in a plain-language report your benefits team, CFO, and broker can act on.

[ No claims data needed to start ][ Independent: paid only by you ][ For employers, brokers & TPAs ]
— Why it matters

Pharmacy is the fastest-growing line in your health plan

A 10,000-member commercial plan typically spends more than $20 million a year on prescriptions, and GLP-1s keep pushing that higher. Finding even 3 to 5% is real money, often without changing your PBM.

$20M+
Typical annual drug spend
10,000-member commercial plan
3–5%
Typical savings range
identified in a first review
$600K–1M
Potential annual impact
for the same plan

Estimate your plan's number with our savings calculator →
See estimates for real self-funded employers in our free plan lookup →
Illustrative estimates based on typical commercial plan drug spend (about $2,400 per member per year in 2025). Your results depend on your claims mix, PBM contract terms, and rebate arrangements.

— What we look at

Where your drug spend has lower-cost options

We compare what your plan pays against generic equivalents, therapeutic alternatives, and public price benchmarks, then flag what it would take to act on each one.

  • Generic equivalents

    Same active ingredient, significantly lower cost.

  • Therapeutic alternatives

    Clinically comparable drugs in the same class, reviewed by a pharmacist.

  • Price benchmarks

    What your plan pays compared with public benchmarks, to spot overpayment and markup.

  • Prior authorization

    Which options need a PBM conversation before you can use them.

— Why StreamRX

Independent analysis from people who've run pharmacies

No conflicts, no black boxes. Just a clear view of your drug spend from a team that knows how pharmacy pricing really works.

01

Paid only by you

No PBM compensation of any kind: no commissions, no rebate sharing, no referral fees.

02

Pharmacist-reviewed

Every alternative is checked by a pharmacist, backed by a team with 40+ years in pharmacy.

03

Flat-fee engagements

We never take a percentage of savings, so our recommendations aren't tied to what we earn.

04

Secure by design

We sign a Business Associate Agreement. Claims data is encrypted, access-controlled, and never shared.

— How it works

From first call to action plan in 4 to 6 weeks

01

Free preview

Share your plan size, plan design, and top drugs. No claims data. We show where opportunities typically sit for a plan like yours.

02

Secure data request

If it's worth a closer look, we sign a BAA and request 12 to 24 months of pharmacy claims from your PBM or TPA.

03

Pharmacist-reviewed analysis

We rank every opportunity by estimated savings, ease of implementation, and clinical impact.

04

Live readout

We walk your HR, finance, and broker teams through the findings and leave you with clear next steps.

Your plan is entitled to its own claims data, and federal law prohibits PBM contract clauses that block access to it. We can help you make the request.

— What you get

A plain-language report your benefits team can act on

The critical data points, ranked, so you know exactly where to start the conversation with your PBM.

Request a preview
[ 01 ]

Drug classes

Which classes have lower-cost generic or therapeutic alternatives.

[ 02 ]

Savings ranges

Estimated savings ranges calculated for your plan size.

[ 03 ]

PA requirements

Prior authorization requirements for every identified alternative.

[ 04 ]

Ranked next steps

Opportunities ranked by likely financial and clinical impact.

— Ways to work with us

Start with one analysis. Keep the savings.

Plans typically find savings opportunities worth many times the cost of the analysis.

Talk to our team
01

Plan analysis

A one-time, pharmacist-reviewed review of your drug spend with ranked savings opportunities. Flat fee.

02

PBM renewal support

Turn your analysis into specific asks for your PBM renewal or RFP, backed by your own data. Timed to your renewal.

03

Ongoing monitoring

Quarterly tracking of spend, new generics, and pricing changes so savings don't slip away. Annual subscription.

— For brokers & TPAs

Bring sharper pharmacy analysis to every renewal

We work alongside benefits brokers, consultants, and TPAs on analyses for their self-funded clients. You keep the relationship; we bring independent, pharmacist-reviewed findings you can put in front of the client.

  • Brokers & consultants

    Independent pharmacy findings for renewal and RFP conversations.

  • TPAs

    A concrete cost-management service you can offer every self-funded client.

  • Employers

    A clear view of where your drug dollar goes, without changing your advisors.

Decision support, not a mandate. We're an analytics service, not a clinical decision tool. Alternatives that look good on paper may not be right for every member. We surface the options and the tradeoffs; your clinical and benefits advisors make the calls.

Savings estimates are ranges. Actual results depend on your claims mix, PBM contract terms, and rebate arrangements.

— FAQ

Self-funded plan analysis, answered

Can't find your answer?
Contact us with any other questions.

Get in touch

No. The free preview uses your plan size, plan design, and top drugs. If it shows enough opportunity to look closer, we request 12 to 24 months of pharmacy claims from your PBM or TPA under a signed Business Associate Agreement.

— Education & research

Expert analysis & intelligence

Deep dives into the financial and operational mechanics of self-funded pharmacy plan design.

All articles
Self-Funded

Federal PBM Reform and Employer Plans: What the 2026 Law Changes, and When

The Consolidated Appropriations Act, 2026 requires PBMs to pass through 100% of rebates to ERISA plans, disclose compensation, and report drug-level data. Here is what changes for self-funded employers, the 2028–2029 timeline, what the law does not do, and what to put in PBM contracts now.

Read article
Self-Funded

Fiduciary Duty and Pharmacy Benefits: What Self-Funded Plan Sponsors Need to Know

Selecting and monitoring a PBM is an ERISA fiduciary act. Here is what the lawsuits against J&J, Wells Fargo, and JPMorgan mean, how the 2026 PBM law changes oversight, and what a prudent, documented pharmacy benefit process looks like.

Read article
Self-Funded

Can Cost-Plus Pharmacies Save a Self-Funded Plan Money?

Cost-plus pharmacies publish their pricing, and research shows big savings on some generics. Here is what the evidence says, the difference between plan savings and member savings, four ways self-funded plans use cost-plus, and the watch-outs.

Read article
Self-Funded

Biosimilars: Is Your Self-Funded Plan Still Paying Brand Prices?

Humira biosimilars now hold most of the market and Stelara biosimilars launched at deep discounts. Here is where adoption stands, why your plan may still pay brand-level prices, private-label biosimilars, and how to switch members well.

Read article
Self-Funded

Specialty Drugs Are Half Your Pharmacy Spend: 5 Ways Self-Funded Plans Manage Them

Specialty drugs are a small share of prescriptions but roughly half of pharmacy spend, and growing fastest. Here are the latest benchmarks and five practical levers: one budget, site of care, biosimilars, the specialty pharmacy channel, and clinical management.

Read article
Self-Funded

5 Costly Mistakes Self-Funded Employers Make With Their Drug Benefit Plans (And How to Fix Them)

Discover the 5 critical, multi-million dollar mistakes self-insured plan sponsors make with their pharmacy benefits, from GLP-1 overspend traps to PBM billing blind spots, and concrete strategies to mitigate them immediately.

Read article
Self-Funded

Are You Leaving Money on the Table? How Self-Funded Employers Are Quietly Overpaying for Prescription Drugs

Prescription drug costs are the fastest-growing line item in most employer health plans today. Discover the hidden economics of PBM plans, the brand-to-generic gap, the rebate trap, and steps to optimize your pharmacy spend.

Read article
— Get started

See where your plan is overpaying

Start with a free preview. Tell us about your plan and we'll show you where opportunities typically sit for a plan like yours.

  • No claims data needed to start
  • Independent: paid only by you, never by PBMs
  • Plain-language results for HR, finance, and brokers

Request a free analysis preview

No claims data needed to start. No commitment.