10/9/2025
Apaly Rx is a first-of-its-kind solution that automatically routes high-cost medication prescriptions—starting with GLP-1s for obesity and diabetes—to the lowest net-cost, plan-approved fulfillment channel.
FOR IMMEDIATE RELEASE
Apaly Health Inc. Unveils Apaly Rx—Dynamic Rx Routing to Lowest Net-Cost GLP-1 Fulfillment for Self-Funded Employers and Commercial Health Plans.
TAMPA, Fla., September 30, 2025 — Apaly today announced Apaly Rx, a first-of-its-kind solution that automatically routes high-cost medication prescriptions—starting with GLP-1s for obesity and diabetes—to the lowest net-cost, plan-eligible fulfillment channel. Built to help self-funded employers and commercial health plans manage accelerating pharmacy spend without sacrificing access, Apaly Rx operates independently or alongside existing GLP-1 and weight-management programs to reduce per-unit costs and sustain coverage.
Employer pharmacy costs tied to GLP-1 use have surged, with PMPM spend jumping markedly and GLP-1s now accounting for a meaningful share of total claims for many plans. In response, sponsors are tightening criteria, shifting cost sharing, and even considering carve-outs. At the same time, the clinical benefits of GLP-1s are compelling: beyond significant weight loss for many patients, semaglutide has demonstrated cardiovascular risk reduction—benefits that make outright exclusions a blunt instrument. Plans need tools that balance affordability and outcomes.
How Apaly Rx Works
Apaly Rx ingests plan rules, member eligibility, and responsibility, then dynamically routes each prescription across plan-approved, Apaly administered fulfillment channels, identifying the lowest net cost option. Apaly administers fulfillment, bills plan charges through claims, and automatically pays pharmacies, creating a seamless experience for members and administrators alike. Because net pricing can vary widely across channels and over time, Apaly Rx delivers continuous, point-of-order optimization that complements existing utilization management, step therapy, and coaching programs.
“Employers are facing real budget shock from GLP-1s—PMPM has risen sharply, and these therapies can represent a sizable slice of total plan claims,” said Jerry Beinhauer, MD, CEO and Founder of Apaly. “We speak with sponsors every day who are tightening criteria or even carving GLP-1s out because the spend feels unsustainable. That’s a lose-lose: members lose access and both plans and members lose long-term health benefits. Apaly Rx changes the equation by routing each fill to the lowest net-cost option allowed by the plan—containing spend without blanket exclusions.”
“Some health plans want a turnkey savings layer; others already run GLP-1 and weight-loss programs with coaching or prior-auth rules,” Beinhauer added. “Apaly Rx works either way—as a standalone optimization engine or in conjunction with those programs. Our goal is simple: lower the per-unit cost so employers can responsibly cover GLP-1s and deliver better cardiometabolic outcomes for their people.”
Coordinating With Apaly’s APC+
When Apaly Rx for GLP-1s is paired with Apaly’s Advanced Primary Care (APC+), sponsors get a unified strategy: APC+ provides clinician-led intake, evidence-based cardiometabolic pathways, and ongoing coaching to ensure GLP-1 therapy for weight loss is medically appropriate—prioritizing lifestyle interventions first and de-escalation when goals are met. For members who meet criteria, Apaly Rx then routes each prescription to the lowest net-cost eligible channel. Together, they reduce avoidable GLP-1 utilization and lower per-unit drug costs, preserving access without sacrificing affordability.
Looking ahead, Apaly designed Apaly Rx as a reusable framework for any category with volatile net pricing—GLP-1s today, oncology and autoimmune biologics next. “What we’ve built isn’t a single-product tool,” said Dr. Beinhauer. “It’s a modular routing and payment engine we can extend to other high-cost therapies by plugging in the right clinical criteria and channels—so plans keep finding the lowest net-cost path as markets evolve.”
Availability
Apaly Rx is available now to self-funded employers, brokers, TPAs, and commercial health plans. To learn more or request a demo, visit www.apalyrx.com.
About Apaly
Apaly is a healthcare technology company based in Tampa, Florida, focused on addressing the root causes of increasing self-funded employer healthcare spend. Founded by Jerry Beinhauer, MD (CEO), Apaly builds solutions that align incentives for employers, providers, and members.
Media Contact
[email protected] | (813) 938-6626
Learn more: www.apalyrx.com
