When Her Medication Was Denied Mid-Treatment, We Didn't Accept That

Pharmacy benefits are confusing.

The industry has spent decades layering complexity on top of complexity, and most people have no idea what they're actually entitled to or how to get it.

At DisclosedRx, we think that's a problem worth solving, one member at a time.

A single mom managing her family's health doesn't have time to spend an hour navigating an automated system.

New parents with a child who has special needs are already carrying more than most people can imagine.

These are real situations, and they happen every day.

Our job is to step in, take it off their plate, and make sure they get what they need.

Here's what that looks like.

She Didn't Have to Figure It Out Alone

A single mom needed medication but didn't know where to start. Between work, kids, and everything else, the last thing she had time for was decoding her pharmacy benefit.

We reached out to her. Walked her through her options, handled the details, and made sure she got what she needed without the runaround.

At the Pharmacy Counter With a Sick Child

A new parent arrived at the pharmacy with their 9-month-old who has special needs. In that moment, there is no time to question the cost. The child needs the medication.

Our team was there to make sure they weren't left to figure it out on their own.

We worked through the coverage, identified the right savings path, and made sure the family paid the lowest possible cost.

Two Days to an Approval

An older member needed a specialty medication but was overwhelmed by the Prior Authorization process.

He needed his daughter's help just to complete the paperwork, and even then, the process felt like too much.

Our Savings Advocate took it from there, submitted the documentation, moved things along, and had an approval in two days. The shipment was scheduled the same day.

This member went from discouraged to taken care of, and the cost was no longer a concern.

No Gap in Treatment

Another member's medication was unexpectedly denied mid-therapy. The member's spouse called us, and it was clear from that conversation how much this medication mattered to their quality of life.

Our Member Advocate coordinated a prior authorization override and secured a copay card to remove the cost barrier. Despite the system working against them initially, there was no gap in treatment.

What Member Services Actually Does

DisclosedRx has two dedicated member-facing teams, each playing a distinct role.

Member Advocates

Member Advocates are available Monday through Friday, 8 AM to 8 PM EST. They handle the everyday, checking coverage, explaining costs, locating in-network pharmacies, resolving claim rejections, and walking members through their portal.

If someone is standing at the pharmacy counter and something doesn't look right, they call us. We figure it out.

Savings Advocates

Savings Advocates work one-on-one with members to identify and enroll them in the right savings program for their specific medication.

That might mean a manufacturer assistance program that provides the medication at no cost, sourcing the same brand-name drug through a licensed pharmacy at a fraction of the cost, or finding and applying a copay card that keeps working refill after refill.

Whatever the path, Savings Advocates stay with the member until it's resolved.

As The Fiduciary and Fully Disclosed PBM®, DisclosedRx is contractually obligated to act in our clients' best interests. Our clients are the only people paying us, and that commitment extends to every member.