The Agent's Guide to GRx for Group Health Insurance

GRx, short for Group Rx (prescription drug) data, is a growing underwriting tool in the group health insurance market. It refers to the use of aggregated prescription claims data to evaluate the overall health risk of a group, helping carriers provide medically-underwritten rates without requiring employees to complete individual health questionnaires. 

As GRx-based underwriting becomes more common, many benefits agencies are looking for guidance on how it works, what’s required, and how to navigate the submission process. In this blog, we’ll explain what GRx is, how it differs from other underwriting tools, and how Quote+ supports GRx carrier submissions.

What is GRx for Group Health Insurance?

Group health insurance carriers use GRx underwriting models, typically powered by third-party data vendors,  to evaluate a group’s health risk based on real prescription drug data. Instead of making clients fill out medical questionnaires, carriers create a risk score that estimates how much a group’s healthcare might cost in the coming year. These scores help group health insurance carriers determine medically-underwritten premiums and enable brokers to present options more efficiently. 

What are The Benefits of GRx?

Group Risk Exchange (GRx) offers a more efficient and data-driven way to price group health insurance, speeding up the quoting process and reducing the burden on employer groups.

In addition to efficiency, GRx can help benefits brokers provide:

• More Accurate Pricing: Carriers using GRx rely on real pharmacy claims instead of traditional medical health questionnaire (MHQ) answers. This means more accurate premiums with less risk of under- or overpricing.
• Faster Quote Process: Quotes come faster because groups don’t have to fill out health forms. Employer groups can more efficiently compare plan options and decide sooner, giving your agency more time to focus on other revenue-generating tasks.
• Better Renewal Predictability: GRx helps group health insurance carriers more accurately forecast future claims risk, leading to steadier renewal pricing compared to traditional underwriting methods.
• HIPAA Compliant & Secure: The GRx process uses de-identified, aggregated data and follows HIPAA rules, easing employer groups' worries.

While GRx is most commonly used with traditional group health insurance, many carriers are starting to apply it to other growing plan types, like level-funded, self-funded, and ICHRA arrangements. This makes GRx an important tool for agents working with multiple group health plans.

What are the Potential Drawbacks of GRx?

However, there are potential drawbacks that are important to note for GRx.

• Fewer Carrier Options: Because many carriers pull GRx data from the same source, groups often receive similar risk scores across the board.  This makes it harder to differentiate between carriers based solely on pricing. 
• Limited Data for Small Groups: GRx examines prescription data rather than a full claims history, which may result in missing some health details for smaller groups. These results can impact the rates for small group health insurance plans.
• Similar Risk Outcomes Across Carriers: If an employer group is considered high-risk, multiple carriers may return similar quotes,  making it more difficult to find a more affordable option.
• Limited Availability: Not all carriers offer GRx-based underwriting in every market, and some still require full MHQs, especially for smaller group sizes.

How to Make Your Agency Stand Out When Carriers Use GRx Data

With the use of GRx becoming more popular, it’s more important to identify how your group benefits agency can stand out from your competition.

• Become the expert advisor: Go beyond quoting. Focus on employer/employee education, claims advocacy, and benefits administration support beyond just pricing.
• Master the data: Learn to read and explain GRx-based quote outputs and carrier-provided risk scores. Translate the complex data into actionable insights for your employer groups.
• Strategically propose GRx: Not every group is a great candidate for GRx. Understand which types of groups and industries could benefit the most from using GRx — and when a traditional MHQ might yield better results.
• Highlight carrier differences: Even with similar rates, carriers can differ in network design, service models, and added benefits beyond underwriting data.

Managing GRx & Other Group Benefits with Quote+ 

Many brokers today are submitting quotes to a mix of carriers, some that use GRx census data and others that still require MHQs. AgencyBloc’s Quote+ solution helps streamline both submission types by centralizing the data collection process and tailoring output to each carrier’s requirements.

With Quote+, your agency can collect employee data once, then generate both MHQ and GRx census submissions as needed, without duplicate work or separate systems. 

Quote+ makes GRx and MHQ submissions easier by offering:

• Hybrid submission support: Submit to GRx-based carriers and MHQ-required carriers simultaneously, using a single intake process for each group.
• Submission-ready forms: Automatically generate the correct submission file or form packet for each carrier, whether it’s an MHQ form or GRx census file.
• Centralized client & submission data: Store census information, MHQs, GRx data, and quote documents all in one platform, making it easy to track activity across carriers.
• Improved efficiency: Reduce manual work, eliminate duplicate outreach, and move groups through the quoting process faster, with better client experiences along the way.

Quote+ enables your team to offer more plan options, respond faster to clients, and maintain clean, compliant records of every submission — whether you’re using GRx, MHQs, or both.

See how AgencyBloc's integrated Plus Suite can help your agency improve your underwriting processes with GRx-generated quotes by managing your business operations, streamlining small group quoting and enrollment, maintaining client connections, and tracking commissions.

Posted by Shannon Beck on Tuesday, July 15, 2025 in Group Benefits

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