Skip Navigation

Pharmacy Solutions

Transparent. Savings-driven. 360° insights.

A smiling pharmacist in a bright pharmacy smiles and holds out a card reader to a brunette customer picking up her prescription.

Advancing Medicaid pharmacy oversight with data-driven performance.

Gainwell Rx™ Pharmacy Solutions provides states with transparency, control, and deep Medicaid expertise for robust pharmacy programs. We meet you where you are—supporting Fee-for-Service (FFS), Managed Care Organization (MCO), and Single Pharmacy Benefit Administrator (SPBMA) or Manager (SPBM)—with conflict-free operations and full visibility into pricing, rebates, and clinical decisions.

Our modular solutions adapt to your needs, supporting policy control from Preferred Drug List management to comprehensive administration. Implementing Gainwell Enterprise™ and Gainwell Rx integrates pharmacy and medical claims that deliver real-time analytics and 360-degree insights, empowering you to control costs, monitor trends, and drive better program outcomes.

Contact us to start the conversation today.

#1

#1

Overall Weighted Score in NASPO for Pharmacy Benefit Services

35+ Million

35+ Million

Medicaid Pharmacy Program Members Served in 20 States / Territories

380 Million

Annual Medicaid Pharmacy Claims Processed 

Pharmacy solutions built for Medicaid performance. 

Pharmacy Benefit Administrator Services

Pharmacy Benefit Administrator Services

Ensure fast, accurate claims and encounters processing with automated, clinically guided prior authorization solutions. These services include support from our omnichannel beneficiary and provider help desks.

Preferred Drug List Management

Optimize state-controlled formulary design, rebate negotiation, and cost optimization. We customize support by state and offer board advising, therapeutic class reviews, pipeline monitoring, and value-based contracts.

Rebate Administration

Take full advantage of Medicaid drug rebates with automated, auditable invoicing, payment, and dispute resolution. Get the benefit of actionable reporting and consistently realize a 98%+ collection rate.

Clinical Management Services

Clinical Management Services

Achieve expert guidance on overall program outcomes and cost management, including benefit design, specialty drugs (including provider-administered drugs), and Retrospective Drug Utilization Review (RetroDUR).

Pharmacy Fraud, Waste and Abuse Audit Services

Use predictive analytics to detect and prevent improper payments, spanning concurrent, desk, and field audits, as well as Special Investigation Unit (SIU) support.

Additional solutions making healthcare more efficient and effective.

Medicaid Enterprise

Modernizing claims, encounters, and financials with intelligent automation and interoperability through Gainwell Enterprise™.

Learn More

Data & Analytics

Transforming your most complex data into actionable insights with Gainwell Genius™.

Learn More

Systems Integration & Interoperability

Accelerating modernization, connectivity, and operational efficiency with Gainwell Connect™.

Learn More

Actionable insights that
empower healthcare progress.

We’re passionate about delivering ideas that can help shape the future of
healthcare, using education and transparency to improve health outcomes for all.

Gainwell Technologies Expands NASPO ValuePoint Footprint with Medicaid Pharmacy Benefits Services Award

Gainwell Technologies Expands NASPO ValuePoint Footprint with Medicaid Pharmacy Benefits Services Award

Learn More
<p>Gainwell Rx</p>

Gainwell Rx

Watch Now
Medicaid Pharmacy: Overcoming FWA Challenges

Medicaid Pharmacy: Overcoming FWA Challenges

Learn More
Explore All Insights

How can we support you?

Start the conversation today.

Contact Us