MedalistRx
- Company typePrivate
- Founded2012
- HeadquartersTulsa, United States
- Headcount11–50
- GTM typeB2B
- OfferingServices
MedalistRx firmographics
Firmographics- Name
- MedalistRx
- Legal name
- Interchange Rx, LLC
- Website
- https://medalistrx.com
- Company type
- Private
- Founded year
- 2012
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Ownership category
- akta.pro rank
MedalistRx industry classification
Industry- Product category
- Pharmacy Benefit Management
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Claims Processing, Adjudication & Payment Integrity (HLAEAKAC)
- akta.pro secondary industries
- Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Manufacturer Contracting, Rebates & Revenue Management (HLAEAKAD), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD)
Keywords
Where MedalistRx is headquartered
LocationHeadquarters
- HQ city
- Tulsa
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
MedalistRx business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- Pharmacy Benefit Management Services: MedalistRx processes and pays prescription drug claims for members, contracts with pharmacies (over 67,000 retail network plus mail-order and specialty), builds and maintains drug formularies, and negotiates discounts and rebates with drug manufacturers. Revenue is generated through negotiated pharmacy pricing spreads, rebate pass-throughs, and administrative fees charged to health plan clients.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Multi-year contract | Transparent PBM pricing with 100% pass-through of pharmacy discounts |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels5 records
MedalistRx product offering
Product offeringCore offering
MedalistRx is a full-service national pharmacy benefit manager (PBM) that processes and pays prescription drug claims for health plan members, contracts with a network of 67,000+ retail pharmacies, builds and maintains drug formularies, and negotiates discounts and rebates with drug manufacturers on behalf of self-funded employers, brokers, unions, TPAs, and public health and welfare trusts. The company delivers core claims processing, specialty medication cost management, mail-order fulfillment via its OptumRx partnership, and proactive member-facing services such as every-claim monitoring, copay assistance enrollment, price transparency, and 24/7 customer support, with 100% pass-through of pharmacy-level discounts to clients.
Product overview
MedalistRx is a full-service national pharmacy benefits manager (PBM) offering a unified platform centered on a proactive 'Every Claim, Every Day' service model. The core MedalistRx PBM platform (core product) handles prescription claims processing, pharmacy network management, and manufacturer negotiations across a network of over 67,000 retail pharmacies. It is supplemented by a suite of analytical and support modules: the Specialty Savings Program (delivers 23–28% specialty drug cost reductions), Price Analysis and Price Transparency tools (real-time pricing visibility and customized reporting), Copay Card Enrollment Assistance (patient enrollment in manufacturer support programs), Claims Discrepancy Resolution (proactive real-time claims monitoring and dedicated resolution team), and Prescription Savings (strategic negotiations and network discounts). Mail-order pharmacy fulfillment is provided via a strategic partnership with OptumRx. All services share a unified data infrastructure enabling the company's signature proactive, high-touch member care.
Differentiator
Problem solved
Functional benefit
Products and services
- MedalistRx PBM Platform Full-service national pharmacy benefit management platform that processes and pays prescription drug claims, contracts with a 67,000+ retail pharmacy network plus mail-order (OptumRx) and specialty pharmacy channels, builds and maintains drug formularies, and negotiates discounts and rebates with drug manufacturers for self-funded health plans, employers, brokers, TPAs, unions, and public health and welfare trusts. Operates a proactive 'Every Claim, Every Day' service model with real-time claims monitoring, a call center that makes four times more outbound calls than inbound, and an 86% generic migration success rate.
- Specialty Savings Program Specialty medication cost-management program for self-funded health plans and plan members that proactively manages high-cost specialty claims through manufacturer copay assistance enrollment and real-time claims monitoring, historically lowering client plan spending by 23-28% while protecting patients with minimal or $0 out-of-pocket costs.
- Mail-Order Medications Mail-order pharmacy fulfillment service delivered through MedalistRx's strategic partnership with OptumRx Pharmacy, enabling members to enroll online at optumrx.com or by calling OptumRx member services (1-800-797-9791) to have prescriptions delivered to their home via OptumRx's mail-order facilities.
- Price Analysis Analytical service providing customized reporting, transparent pricing insights, proactive cost management strategies, and expert guidance to help health plans identify cost-saving opportunities and optimize prescription medication spending.
- Price Transparency Price transparency and pricing clarity service delivering real-time prescription pricing updates, clear and comprehensive cost breakdowns, and user-friendly platforms giving members and organizations complete visibility into medication costs, supported by 100% pass-through of pharmacy-level discounts with no hidden spreads, clawbacks, or additional fees.
- Copay Card Enrollment Assistance Enrollment support service that helps members and organizations navigate copay card enrollment processes, identify eligible medications, explore manufacturer copay assistance programs, and maximize savings on prescription costs through proactive outreach and dedicated enrollment support, applying for and receiving copay assistance for 96% of high-cost patients served.
- Claims Discrepancy Resolution Proactive claims management service employing real-time monitoring, a dedicated claims resolution team, transparent communication, and thorough investigation to identify and resolve claims discrepancies before they escalate, minimizing disruption to members' healthcare experiences.
- Prescription Savings Comprehensive prescription cost-reduction service leveraging strategic cost negotiations with pharmacies and manufacturers, an extensive network of over 67,000 retail pharmacies, proactive cost management strategies, and fully transparent pricing to deliver predictable and manageable prescription costs for individuals and organizations.
- True Out of Pocket Reporting Proactive brand medication management program that tracks and maximizes manufacturer copay assistance resources, guiding members to reduce or eliminate out-of-pocket costs while lowering client plan costs by 36% — with members in the program paying just 4% of their brand copay (a 96% drop in out-of-pocket expense).
Quantifiable outcome
- 23-28% reduction in client plan spending on specialty medications
- +6 more outcomes
Companies that use MedalistRx
Customer profileNamed customers1 record
Segments5 records
Ideal customer profiles5 records
MedalistRx technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
Feature6 records
MedalistRx partnerships and signals
Strategic signalPartnerships
Two partnerships are on record, tiered core and minor.
- OptumRxcoreMedalistRx has a strategic partnership with OptumRx Pharmacy for the fulfillment of mail-order pharmacy prescriptions. OptumRx's mail-order facilities service MedalistRx members across the United States, providing a seamless integration between MedalistRx's PBM platform and OptumRx's mail-order fulfillment capabilities. MedalistRx also uses OptumRx's pharmacy locator tool for its members.
- Tulsa Fraternal Order of Police Health and Welfare TrustminorThe Tulsa FOP Health & Welfare Trust (representing Tulsa Police Department employees) is a MedalistRx customer that has provided a formal endorsement of the company's PBM services, specifically citing MedalistRx's 'Every Claim, Every Day' proactive claims monitoring as a differentiating feature they verified firsthand.
Scale indicators10 records
Recent moves6 records
Expansion highlights5 records
MedalistRx competitors and assessment
Company assessmentMarket position
Competitive moat5 records
Key highlights7 records
Customer concentration
MedalistRx social profiles
Digital presenceMedalistRx financial estimates
Financial estimateRevenue estimate
Valuation estimate
MedalistRx leadership team
Management profileNumber of profiles
Profiles3 records
MedalistRx funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
MedalistRx M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about MedalistRx
What does MedalistRx do?
MedalistRx is a full-service national pharmacy benefit manager (PBM) that processes and pays prescription drug claims for health plan members, contracts with a network of 67,000+ retail pharmacies, builds and maintains drug formularies, and negotiates discounts and rebates with drug manufacturers on behalf of self-funded employers, brokers, unions, TPAs, and public health and welfare trusts. The company delivers core claims processing, specialty medication cost management, mail-order fulfillment via its OptumRx partnership, and proactive member-facing services such as every-claim monitoring, copay assistance enrollment, price transparency, and 24/7 customer support, with 100% pass-through of pharmacy-level discounts to clients.
Is MedalistRx a public or private company?
MedalistRx is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was MedalistRx founded?
MedalistRx was founded in 2012. It employs 11 to 50 people.
Where is MedalistRx based?
MedalistRx is headquartered in Tulsa, United States, in the North America region.
How does MedalistRx make money?
One revenue line is on record: pharmacy Benefit Management Services.
Does MedalistRx have an API?
No public API is recorded for MedalistRx.
What industry is MedalistRx in?
MedalistRx's product category is Pharmacy Benefit Management. Its primary akta.pro industry code is HLAEAKAC, Claims Processing, Adjudication & Payment Integrity, with a secondary code of HLAEAKAE, Specialty Pharmacy Benefit Management (Specialty PBM). Its NAICS code is 524292 and its SIC code is 6324.