Pharmacy Benefit Managers

A pharmacy benefit provider is a third-party administrator of prescription drug programs that offers services of prescription drug benefit management for employees.
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Rightway

Rightway

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Company Overview

Founded

2017

Employees

500

Funding Summary

130M Corporate Round

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About Rightway

Rightway’s human-led clinical care navigation solution guides over one million members to the highest-quality care by inserting clinicians into the member care journey. Powerful technology enables personalized and proactive clinical support at a fraction of the cost of other solutions and is proven to lower healthcare costs by 15%.

Rightway works with benefits leaders to identify top healthcare-related objectives for their population and helps them control how their members use healthcare. Our live guides deliver care decision support, benefits education, steerage to high-quality providers, and billing advocacy. By providing complete healthcare support for members, Rightway helps benefits... Show More
Best Money Moves LLC

Best Money Moves LLC

4.6 (14)
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Founded

2016

Employees

20

Funding Summary

750K Seed Round

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About Best Money Moves LLC

Best Money Moves is a mobile-first financial wellness program that combines technology, information, tools and live money coaching to help employees measure their level of financial stress in 15 categories, and then sends relevant information and tools to help them reduce that stress. An ongoing engagement strategy keeps usage well above EAP rates.

Employees use the program’s point-based rewards system, which assigns point values to every action possible: setting up income and expenses inside the budget tool, reading articles, measuring stress, etc. All of these items, plus the leaderboard, are seen on the Employee Dashboard.
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ClaimChoice Administrators

ClaimChoice Administrators

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Founded

2018

Employees

29

Funding Summary

Not Provided

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About ClaimChoice Administrators

ClaimChoice Administrators is one of the largest independent administrators of self-funded union, traditional and association health plans in the country bringing more than 30 years of staff experience in delivering integrated, customized benefit solutions, that blend flexibility and customization, unlike anyone else in the marketplace. Show More
Nomi Health

Nomi Health

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Founded

May 2019

Employees

Funding Summary

110M Series A

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About Nomi Health

From patient care to provider payments, we're rebuilding no-nonsense healthcare that is truly direct and affordable by changing how healthcare is delivered, purchased, and paid for. Show More
Crumdale Partners

Crumdale Partners

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Founded

2014

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Funding Summary

Not Provided

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About Crumdale Partners

Crumdale Partners is a diversified insurance firm providing custom, self-funded healthcare solutions to a bespoke set of brokers, consultants, and agents nationwide. We optimize the fragmented health benefits supply chain to reduce health benefit costs and create better outcomes for employers and employees. We sell integrated and unbundled solutions to brokers looking for flexibility in their self-funded and level-funded health plans, pharmacy benefits, stop-loss, actuarial and compliance needs.­ 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
Advanced Medical Pricing Solutions (AMPS)

Advanced Medical Pricing Solutions (AMPS)

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Founded

2005

Employees

88

Funding Summary

Not Provided

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About Advanced Medical Pricing Solutions (AMPS)

Turn to Advanced Medical Pricing Solutions (AMPS) for your healthcare cost management services and we will help you achieve meaningful and visible savings for your clients. Here at AMPS we utilize physicians to perform line-by-line audits on all claims we review. This will not only demonstrate an added level of commitment to your clients, it will add a new line of revenue to YOUR company at ZERO expense to you.
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AscellaHealth LLC

AscellaHealth LLC

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Founded

2013

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Funding Summary

None

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About AscellaHealth LLC

A premier, tech-enabled Specialty Pharmacy and Healthcare Services organization serving Patients, Payers, Life Sciences, and Providers with innovative, cutting-edge clinical programs and services to improve health outcomes and enhance the patient journey.

We are always looking to expand our team with talented individuals, if you are interested in learning more, please send us an email to careers@ascellahealth.com and attach your resume. Show More
Integrated Prescription Management

Integrated Prescription Management

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Founded

2009

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Funding Summary

Not Provided

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About Integrated Prescription Management

Integrated Prescription Management (IPM) is a full-service pharmacy benefits manager (PBM) that works with self-funded employer groups, brokers, and TPAs around the country. Known for our high-touch service, insightful analytics, and flexible benefit designs, we take a collaborative approach to controlling costs without compromising care. Show More
Kroger Prescription Plans

Kroger Prescription Plans

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Founded

1993

Employees

Funding Summary

None

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About Kroger Prescription Plans

Kroger Prescription Plans is dedicated to providing pharmacy benefit management services and innovative clinical programs that focus on engagement, choice, and cost savings. Built on personalized care solutions that simplify health, wellness and nutrition, Kroger Prescription Plans is the catalyst to combining a full suite of Kroger Health entities to improve health and deliver savings. The company provides pharmacy benefit management services to a wide range of employers across the United States, including The Kroger Co., the 4th-largest employer in the United States.
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ManifestRx

ManifestRx

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Founded

2021

Employees

Funding Summary

Not Provided

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About ManifestRx

ManifestRx strives to provide price transparency and a frictionless pharmacy experience. ManifestRx is removing the barriers, frustration, and confusion associated with third-party contracting and delivering a convenient, simple solution. The family of companies delivers integrated pharmaceutical delivery with Manifest Pharmacy and enterprise pharmacy benefit solutions through ManifestRx.

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MedOne Pharmacy Benefit Solutions

MedOne Pharmacy Benefit Solutions

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Founded

1999

Employees

80

Funding Summary

Not Provided

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About MedOne Pharmacy Benefit Solutions

MedOne is your key to the pharmacy benefit marketplace. We unlock the most appropriate prescription at the most affordable price for organizations and their health plan members nationwide. The MedOne 100% pass-through model delivers real prescription savings by cutting out the traditional "PBM"​ middlemen and facilitating direct relationships between health plans and high-performing pharmacies. Once we establish a transparent and aligned marketplace, we partner with organizations to optimize "where"​ and "what"​ members fill to reduce pharmacy costs and improve health outcomes.
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National Script, LLC

National Script, LLC

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Founded

August/2014

Employees

8

Funding Summary

Not Provided

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About National Script, LLC

We are a PBM focused on reducing our client and their members' costs through transparent and honest plan governance. We provide plan flexibility and superior member service to deliver the plan management desired by the employer. Show More
VIVIO

VIVIO

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Founded

2016

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Funding Summary

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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
MedImpact Healthcare Systems, Inc.

MedImpact Healthcare Systems, Inc.

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Company Overview

Founded

1989

Employees

1,606

Funding Summary

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
Vivid Clear Rx

Vivid Clear Rx

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Founded

2020

Employees

Funding Summary

Not Provided

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About Vivid Clear Rx

Introducing an Employee-Owned PBM that holds the cultural backbone of its 90-year-old parent company, Hy-Vee, Inc. with a focus on quality, healthy lifestyles and superior customer service.
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Transcarent

Transcarent

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Founded

2018

Employees

240

Funding Summary

126M Series D

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About Transcarent

Transcarent is a consumer digital health company that puts people in charge of their health and care experiences. Transcarent provides a consumer-directed platform using a combination of software, technology, Health Guides and data science to empower consumers with the kind of unbiased information, trusted guidance and access to high-value care that leads to better care and better outcomes. Show More
A-S Medication Solution

A-S Medication Solution

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Founded

1988

Employees

Funding Summary

Not Provided

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About A-S Medication Solution

A-S Medication Solutions (ASM) and its affiliates are privately owned companies founded in 1968. ASM is the leading provider of on-site dispensing and currently services over 3,600 provider dispensing sites as well as several on-site close system pharmacies. ASM is registered with the FDA, DEA and licensed with all 50 states who focuses on a closed system distribution model capable of providing medications to both clinics and pharmacies at all levels. In addition, ASM is VAWD accredited with NABP, which validates a secure medical supply chain at the highest levels by the prestigious national association of boards of pharmacy. Finally,... Show More
Allign RX (GOODROOT)

Allign RX (GOODROOT)

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Funding Summary

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About Allign RX (GOODROOT)

Goodroot is an interconnected community of companies making every interaction between human and health accessible, affordable and seamless. As a proven healthcare innovation partner, Goodroot delivers transformative tech and proactive services that enable clients, partners and patients to reap more value from the money spent on health. We’re laser-focused on holistically reinventing healthcare, one system at a time, to improve affordability and accessibility for patients.

Our community of companies, founded in 2020, has attracted over 100 seasoned industry veterans, who left their previous roles behind to change the world. Together, we’ve removed $1 billion in wasteful... Show More

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Frequently Asked Questions

What Is Pharmacy Benefit Management?

Pharmacy benefit management (PBM) is a service that coordinates and administers prescription drug benefits on behalf of health insurers, employers, pharmacies, and other payers. PBM providers act as intermediaries, negotiating lower drug costs, processing claims, and administering pharmacy networks to ensure cost-effective and efficient medication delivery.

What Is a Pharmacy Benefit Manager?

Pharmacy Benefit Managers (PBMs) are third-party administrators who operate and manage prescription drug benefits for health plans. They create formularies, negotiate rebates, process claims, manage pharmacy networks, and review drug utilization.

How Pharmacy Benefit Management Works?

Pharmacy benefit management serves as a bridge between all parties involved in delivering medications to the patient. The managers negotiate lower drug prices and rebates with drug manufacturers. They manage prescription drug plans for insurers and ensure pharmacies are reimbursed. Then, PBMs handle prescription claims processing, making it easier for patients to get their medications.

What Is the Difference Between Medical Benefits and Pharmacy Benefits?

Medical benefits typically include doctor visits, hospitalization, surgeries, and other medical procedures. On the other hand, pharmacy benefits specifically cover prescription medications and related services, including drug formulary management and medication distribution through pharmacy networks.

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