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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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
BeneCard PBF

BeneCard PBF

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Founded

1989

Employees

525

Funding Summary

Not Provided

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About BeneCard PBF

BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Our transparent business model operates on a customized claim processing system offering unlimited capability and flexibility to respond to client needs in an evolving marketplace.

Advanced clinical programs and advanced technology provide the framework to maximize the use of all data elements available. This allows BeneCard PBF to filter the information, focus on clinical opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively promote complete health care.

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Abarca Health

Abarca Health

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Founded

2005

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Not Provided

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About Abarca Health

Abarca is igniting a revolution in healthcare. We are starting by redefining pharmacy benefits, but this is just the beginning. We built our company on the belief that with smarter technology and a straightforward approach to business, we can provide a better experience and greater value for payers and consumers.

For nearly a decade, we have challenged many industry conventions and trampled on a few. So call us a PBM for discussion purposes, but we are unlike any other company out there. And today, we manage over $2 billion in drug spending for millions of Americans, with... 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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PharmPix Corp

PharmPix Corp

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Founded

2009

Employees

140

Funding Summary

Not Provided

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About PharmPix Corp

Pharmpix is a full service URAC Accredited Pharmacy Benefit Management Company (PBM) with an adaptable business model for distinct pharmacy delivery solutions. We provide services to health plans who manage Medicare, Medicaid and commercial business. Our system and coordinated (PBM) services are also built for large employers/unions and worker’s compensation lines of business. The company is privately held and was organized in 2009 as a corporation. Our headquarters are located in Guaynabo, Puerto Rico.

Our main differentiation among others PBMs are that we operate as a technology focused PBM, serving cost-conscious pharmacy benefit payers and/or administrators... Show More
Alluma

Alluma

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None

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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
Capital Rx

Capital Rx

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Founded

2017

Employees

400

Funding Summary

106M Series C

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About Capital Rx

Capital Rx is built around the mission to change the way prescription drugs are priced and patients are serviced. A health technology company daring to reimagine the pharmacy benefits industry, Capital Rx is executing its mission through a combination of our Clearinghouse Model® - the first ethical framework for drug pricing - and our custom-built enterprise pharmacy platform, JUDI®, which connects every aspect of the pharmacy ecosystem in one platform, enabling patient engagement, and increasing operational efficiency to achieve the highest standards of clinical care. Show More
Citizens Rx

Citizens Rx

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Founded

2010

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Funding Summary

Not Provided

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About Citizens Rx

Citizens Rx was founded by a group of industry leaders that recognize there is a better way for pharmacy benefit services to be constructed and delivered. Based on the collective experience of the founders, which covers every conceivable area of the business, the enterprise has assembled a world-class management team and exceptional resources.
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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
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
Maxor National Pharmacy Services, LLC

Maxor National Pharmacy Services, LLC

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Founded

1926

Employees

Funding Summary

None

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About Maxor National Pharmacy Services, LLC

Maxor is a market-leading Pharmacy Benefit Manager that delivers service excellence with innovative capabilities in clinical management, analytics, and member engagement to help clients lower pharmacy costs while improving health outcomes. Maxor’s PBM platform is complemented by Maxor Pharmacy Management & Consulting Services, a provider of outpatient pharmacy management solutions, and Maxor Specialty, a clinically-driven specialty pharmacy focused on rare and orphan diseases. These capabilities allow Maxor to offer customized solutions to diverse market segments including hospitals and health centers, employers, labor groups, and public entities. Show More
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
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
Payer Matrix

Payer Matrix

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Founded

2016

Employees

203

Funding Summary

Not Provided

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About Payer Matrix

Payer Matrix was founded in 2016 as we saw a critical need for a solution to address the rising specialty drug costs and their impact on plan budgets. We focus on patient advocacy, with the goal of providing a substantial cost saving to our clients and members who may not otherwise have this type of discounted access to the affordable drugs they need.

Our founder and the senior management team have considerable experience in the healthcare industry, focused on specialty pharmacy, home infusion, and employee benefits. Our experience gives us the unique ability to provide specialized patient... Show More
PerformRx

PerformRx

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Founded

1999

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Funding Summary

None

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About PerformRx

Formed in 1999, PerformRx, LLC is a URAC accredited pharmacy benefits manager servicing lines of business including Medicaid, Medicare, and Commercial markets. A large percentage of the staff at PerformRx are pharmacists and pharmacy technicians. This ensures that the company maintains a culture of clinical influence and care throughout each business area.

Clients receive a personalized solution designed to understand their benefit and meet their needs. This includes offering clients standalone products and services as well as full pharmacy benefit management. PerformRx ensures these solutions by utilizing technology that adapts to specific member populations and changes in... 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
Sav-Rx Prescription Services

Sav-Rx Prescription Services

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Founded

1966

Employees

350

Funding Summary

Not Provided

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About Sav-Rx Prescription Services

Sav-Rx Prescription Services, a wholly owned subsidiary of A&A Services, LLC, is the leading provider of lowest net cost Medication Benefit Management for employers and health plans nationwide. Sav-Rx serves millions of lives in all 50 states and Puerto Rico. After 50+ years in business, Sav-Rx remains 100% family-owned and operated, headquartered in Fremont, Nebraska, and anchored in the same community-based, patient-focused values we started with in 1966. Show More
WellDyne

WellDyne

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Founded

1990

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Funding Summary

None

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About WellDyne

WellDyneRx is a full-service, independent Pharmacy Benefit Manager (PBM) that makes the little things matter for our clients, employees, partners, and members.

Because we are an independent PBM—meaning we are not owned by a pharmacy, drug company, or health insurance provider—we are able to negotiate freely on your behalf to keep costs low and quality of care high for our clients and members.

As early pioneers in clinical pharmacy, WellDyneRx has a history of caring for patients differently and always from a pharmacological perspective. We don’t just fill prescriptions. We constantly manage and optimize... 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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EmpiRx Health

EmpiRx Health

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Founded

2014

Employees

130

Funding Summary

Not Provided

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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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