Smithrx

SmithRx is a pharmacy benefits management (PBM) company that administers prescription drug benefits for self-insured employers, positioning itself as a "modern PBM" built on pass-through pricing and disclosure of drug costs. The company operates independently of insurers and pharmacies and passes 100% of negotiated discounts and manufacturer rebates through to clients, earning revenue from per-member, per-month administrative fees rather than spread pricing or rebate retention. Its service model routes each claim toward what it describes as the lowest net cost combination of drug, pharmacy and price, supported by clinical review, prior authorization processing, formulary management and patient advocates who review prescriptions for lower-cost options.

The platform includes an employer/broker portal for tracking plan performance and savings and a member portal for viewing plan details, benefit summaries, spend tracking, formulary information, refills, claim and prior authorization status, and a "Find My Meds" lowest-cost pharmacy search tool. Members have access to a national network of more than 56,000 pharmacies spanning national retailers, regional chains, mail order and independent pharmacies; SmithRx states it works directly with independent pharmacies on reimbursement benchmarks such as NADAC, PAC or AWP. Cost-savings programs have included alternative sourcing (originally branded SmithRx Connect and later Connect 360, since rebranded as Drug Pathways and its Drug Pathways Engine), Autoimmune Savings, Low-Cost Insulin and direct-to-employer GLP-1 pricing.

The company is legally identified as Smith Health, Inc. and maintains offices in California and Utah. It is a founding member of Transparency-Rx, a coalition advocating prescription drug pricing reform.

Founding story

Founder and CEO Jake Frenz's experience with the U.S. healthcare system shaped the company: at 22 he became a caregiver during his father's cancer treatment, later faced his own cancer diagnosis that threatened amputation of his leg, and subsequently managed specialty medications while caring for his mother during a long-term illness. Those experiences with opaque and inefficient benefits led him to found SmithRx to bring transparency and fairness to pharmacy benefits management. Before SmithRx, Frenz built the operations organization at Collective Health and led program teams delivering commercial and Medicare healthcare products at Anthem; he previously served as a Captain and logistics officer in the Marine Corps with two tours in Iraq and co-founded CombatIV, an infusion-pump IV device for combat zones. He holds a B.S. in Finance and Economics from the University of Colorado and an MBA from UCLA.

Business model

SmithRx contracts with self-insured employers to administer pharmacy benefits, passing 100% of pharmacy discounts and manufacturer rebates to clients and charging straightforward per-member, per-month administrative fees instead of profiting from spread pricing or rebate retention. It operates independently of insurance companies and pharmacies, which it presents as aligning its incentives with plan sponsors and members.

Per-member, per-month administrative fees paid by client employers; the company states it retains none of the drug discounts or rebates it negotiates.

Traction

The company reported more than 1,100 employer clients as of its March 2022 Series B announcement. It cites average client savings of over 20% of total drug costs, a client satisfaction score of 4.7 out of 5 and PMPM costs more than 20% below industry benchmark based on 2025 client data and survey results. A published case study for agricultural client Keystone reports $1.8M in drug pathway savings and 40% average PMPM savings from Q1 2024 to Q3 2025. Its partnership with Mark Cuban Cost Plus Drug Company was reported to have generated $9.5 million in client savings through autoimmune drug sourcing.

Latest developments

The company reports 2025 client survey and claims data showing 20%+ average savings and a 4.7/5 client satisfaction score, published a Keystone case study covering Q1 2024 through Q3 2025, retired the Connect 360 brand in favor of Drug Pathways powered by its Drug Pathways Engine, and is publishing employer guidance on CAA 2026 contract requirements, prior authorization program evaluation and sustainable GLP-1 coverage with direct-to-employer pricing.