PBM Companies

Pharmacy benefit management companies (PBM) or third-party administrators of a prescription drug program that manage prescription drug benefits on behalf of health insurers.
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Capital Rx

Capital Rx

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-

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-

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Product Features

✓

Balance Bill Protections

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Patient Assistance Program (PAP)
✓

Manufacturer assistance fill-in

 ✓

Pass-Through, Admin Fee Only Contracts
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Product Description

In 2018, Capital Rx redefined the role of a pharmacy benefit manager (PBM) and what it means to be a transparent PBM, bringing a unique level of financial alignment to the industry. Offering... Show More
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Evernorth

Evernorth

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Founded

2020

Employees

71,000

Funding Summary

Not Provided

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About Evernorth

Evernorth brings together a powerful set of health services strengths to advance innovation now and for the future. Evernorth will drive value for you by leveraging our game-changing capabilities, our deep understanding of health conditions and disease states, and our connections across the health ecosystem to deliver solutions designed with your specific needs in mind. Our unique open architecture will connect multiple point solutions across your portfolio, improving our ability to better meet your needs while providing you choice and optionality. Show More
Express Scripts

Express Scripts

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Founded

1986

Employees

13,721

Funding Summary

Not Provided

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About Express Scripts

We’re a health care opportunity company, tackling the problems others don’t, won’t or can’t. Where some see obstacles, we see possibilities. At Express Scripts, we dare to imagine a better health care system, and we’re driven to make it happen. We’re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all. We are Champions For Better.

Express Scripts has a deep history as an industry innovator, every day striving for better. Standing with those we serve, we collaborate with our clients and partners to develop... Show More
OptumRx

OptumRx

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Optum Rx is a PBM. Show More
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MedImpact Healthcare Systems, Inc.

MedImpact Healthcare Systems, Inc.

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Founded

1989

Employees

1,606

Funding Summary

1 Corporate Round

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About MedImpact Healthcare Systems, Inc.

For more than 30 years, MedImpact has been lowering cost, improving care, and delivering better solutions for our clients. Today, we are the largest independent pharmacy benefit solutions company, investing millions of dollars in clinical programs, technology, operations, and analytics to provide clarity, control, and confidence.
Clarity
MedImpact's comprehensive pharmacy benefit solution includes innovative clinical programs and cost analytics with clear information empowering clients and their members in making the best care and cost decisions.
Control
MedImpact provides our capabilities, services, solutions, and products under any service model our clients desire allowing clients control and flexibility... Show More
EmpiRx Health

EmpiRx Health

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Founded

2014

Employees

130

Funding Summary

Not Provided

Clients Your Size Clients Your Size

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SmithRx

SmithRx

4.6 (2)
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Founded

2016

Employees

0

Funding Summary

20M Angel Round

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About SmithRx

SmithRx is committed to providing a straightforward approach to reducing drug costs and improving health outcomes. We understand that reducing pharmacy costs is top of mind for us all. We utilize cloud technologies to deliver the most streamlined and cost-effective PBM solution: one that is modularized and can be tailored to meet individual needs.
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Transcarent

Transcarent

2.0 (1)
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Min. Group Size

1,000 eligible

Lives Serviced

-

Average Cost

Average Cost is Locked

0 RFI Questions Get access to vendor answered question RFIs.

RFI questions number is Locked

26 Specific Questions Specific Questions

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Product Features

✓

Balance Bill Protections

 ✓

Patient Assistance Program (PAP)
✓

Manufacturer assistance fill-in

 ✓

Pass-Through, Admin Fee Only Contracts
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Not Provided.

Product Description

The market’s only fully integrated, pharmacy-forward navigation and PBM platform delivering the lowest net cost, complete oversight, and real-time Member guidance.  As prescription costs surge, now accounting for 25% of employer healthcare spend, traditional... Show More
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Rightway

Rightway

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Min. Group Size

500 eligible

Lives Serviced

100,000

Average Cost

Average Cost is Locked

0 RFI Questions Get access to vendor answered question RFIs.

RFI questions number is Locked

26 Specific Questions Specific Questions

Lock

Product Features

✓

Balance Bill Protections

 ✓

Patient Assistance Program (PAP)
✓

Manufacturer assistance fill-in

 ✓

Alternative drug sourcing
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Not Provided.

Product Description

Rightway’s reimagined full-stack PBM solution dismantles the traditional PBM model and fundamentally redesigns the member experience, reducing total pharmacy spend, guiding members to optimal medication regimens, and proactively engaging high-risk and specialty members.... Show More
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Alluma

Alluma

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Founded

2019

Employees

222

Funding Summary

None

Clients Your Size Clients Your Size

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About Alluma

Alluma is shifting the focus back to patient care by creating a new entity that is uniquely aligned to the needs of its clients and their members. With a Pharmacy Benefits Illuminator, we negotiate on the same side of the table as our clients, helping them uncover opportunities that optimize their benefits programs while supporting better health outcomes.

We are a provider-led, provider-focused alternative developed in partnership between Vizient and Mayo Clinic. As the nation’s only member-owned, member-driven performance improvement company, Vizient is uniquely positioned to approach the PBM market with a provider lens. Mayo Clinic is... Show More
BeneCard PBF

BeneCard PBF

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Min. Group Size

-

Lives Serviced

-

Average Cost

Average Cost is Locked

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Product Features

✓

All Specialty Pharmacies Allowed

 ✓

Multiple formulary options
✓

Flexible plan design options

 ✓

Utilization management
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Product Description

For over forty years, BeneCard PBF has been at the forefront of helping a diverse range of clients, from large corporations to small businesses and labor unions, to optimize their prescription drug programs.... Show More
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Navitus Health Solutions

Navitus Health Solutions

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Founded

2003

Employees

948

Funding Summary

None

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About Navitus Health Solutions

Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company. As a zero-spread, full pass-through pharmacy benefit manager (PBM), Navitus aligns performance with plan sponsors’ benefit goals to deliver comprehensive clinical programs and costsaving strategies that lower drug trend and promote good member health. Navitus provides its flexible services to individuals and group plans, including state employees, retirees and their dependents, as well as employees or members of managed care organizations, self-funded employers, coalitions and labor organizations.

Reminder: Please do not post personal health information on this site.

Navitus is committed... Show More
Prime Therapeutics

Prime Therapeutics

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Founded

1987

Employees

0

Funding Summary

None

Clients Your Size Clients Your Size

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About Prime Therapeutics

Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years.

In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 27+ million members throughout the US.

In addition to core PBM services, we... Show More
MakoRx

MakoRx

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Founded

2019

Employees

5

Funding Summary

Not Provided

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About MakoRx

MakoRx provides cost-plus pharmacy benefits to employers via our PBM services and subscription-based plans. We strive to make medications accessible to everyone and bring transparency to the pharmacy benefits space. We are avid patient advocates with a dedicated team of pharmacists on-hand to assist with member questions. We work with healthcare partners to help them complete the care cycle by including free or low-cost medications. We also partner with consultants and employers looking to diversify and enhance traditional health benefit options. Show More
Prescryptive Health

Prescryptive Health

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Founded

2017

Employees

150

Funding Summary

26M Series A

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About Prescryptive Health

Founded in 2017 by Microsoft cloud veterans, Prescryptive Health is a healthcare technology company rewriting the script for the US pharmaceutical market. We believe that by empowering consumers to own their prescription, we can fundamentally change the prescription drug market.

Our mobile-first, blockchain-powered platform fosters fair pricing, patient access to medication, increased adherence, and patient engagement. Our goal: enable employers, health systems and health plans, pharma manufacturers, pharmacies, and consumers to connect and collaborate in a more equitable and transparent ecosystem.

Find out more at Prescryptive.com or on LinkedIn. #letsrewritethescript Show More
Imagine360

Imagine360

5.0 (1)
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Founded

1968

Employees

1,400

Funding Summary

Not Provided

Clients Your Size Clients Your Size

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About Imagine360

Imagine360 has 50+ years of combined experience. In 2020, Group and Pension Administrators (GPA) joined forces with ELAP Services, EBMS, and Imagine Health, which became sibling corporations through WaterStreet Healthcare Partners. This integration allows our organization to deliver the most experienced and first completely integrated health plan with reference-based pricing as its core.

Imagine360 delivers a fully integrated health plan with the savings of reference-based pricing built in and consistently generates 15–25% savings for 900+ self-funded employers. Imagine360 is entering its next phase of growth with a fresh infusion of capital to expand its comprehensive suite... Show More
Kroger Prescription Plans

Kroger Prescription Plans

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Product Info

Min. Group Size

50 eligible

Lives Serviced

400,000

Average Cost

Average Cost is Locked

0 RFI Questions Get access to vendor answered question RFIs.

RFI questions number is Locked

26 Specific Questions Specific Questions

Lock

Product Features

✓

Patient Assistance Program (PAP)

 ✓

Manufacturer assistance fill-in
✓

Alternative drug sourcing

 ✓

Pass-Through, Admin Fee Only Contracts
Show All Features

Not Provided.

Product Description

KPP was created by Kroger for their own employees. This drives us to provide cutting edge clinical programs with the purpose of cost savings, safety, and effective outcomes. We are able to use... Show More
Company Overview
RxSense

RxSense

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Product Info

Min. Group Size

1,000 eligible

Lives Serviced

4,500,000

Average Cost

Average Cost is Locked

0 RFI Questions Get access to vendor answered question RFIs.

RFI questions number is Locked

26 Specific Questions Specific Questions

Lock

Product Features

✓

Manufacturer assistance fill-in

 ✓

Pass-Through, Admin Fee Only Contracts
✓

Rebate administration

 ✓

All Specialty Pharmacies Allowed
Show All Features

Not Provided.

Product Description

RxSense is not a PBM. However, we provide all the necessary tool to enable other PBMs. We currently partner with the following PBMs:

- Optum
- CVS/ Caremark
... Show More
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VIVIO

VIVIO

5.0 (1)
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Founded

2016

Employees

0

Funding Summary

Clients Your Size Clients Your Size

Clients size is Locked

About VIVIO

We use data to understand what specialty drugs do at the individual, not population level. Our carveout product, VIVIO Precision Care™ fixes big unsolved healthcare problems: expensive drug therapies that don’t work; lack of real-world effectiveness; doctors not knowing what they think they know; the arbitrary line between pharmacy drug and medical benefit; and, egregious supply chain waste. We replace the current pharma-centric therapeutic model with our data-centric one and drive better patient outcomes without overpaying. Employees and physicians have access to the right drugs based on individual data rather than self-serving policies. Typically, we save large and mid-sized self-insured... Show More
ClearScript

ClearScript

Reviews pending
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Founded

2005

Employees

0

Funding Summary

None

Clients Your Size Clients Your Size

Clients size is Locked

About ClearScript

ClearScript is a comprehensive pharmacy benefit manager serving self-funded employer plans throughout the United States. Our business model is centered around value, savings and clarity. Our products and services are designed to optimize our clients’ financial performance while delivering exceptional health outcomes.

As a part of Fairview Health Services, a leading non-profit health system, we have unparalleled clinical experience and access to innovations in drug therapy management.

Services include nationwide pharmacy network and claims processing, mail service, specialty pharmacy, utilization management programs (prior auth, quantity limits, step therapy, OTC preferred, more), medication... Show More

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Frequently Asked Questions

What is a PBM?

A PBM, or pharmacy benefit manager, is a third-party administrator that manages prescription drug benefits for health insurers and employers. PBMs negotiate drug discounts, maintain formularies, and help control drug costs while ensuring medication safety for plan members.

What does a PBM do?

A PBM, or pharmacy benefit manager, negotiates drug discounts, maintains formularies, and helps control medication costs for health insurance plans and employers. They also ensure medication safety and provide services for efficient prescription processing.

How does a PBM work?

A PBM negotiates drug discounts, manages prescription drug programs and formularies, controls medication costs, ensures medication safety, and facilitates efficient prescription processing by intermediating between pharmaceutical companies, pharmacies, and health plan sponsors.

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