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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Capital Rx

Capital Rx

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Company Overview

Founded

2017

Employees

1,050

Funding Summary

252M Series F

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About Capital Rx

Capital Rx’s original mission was to redefine how prescription drugs are priced and patients are cared for to create enduring social change as a transparent pharmacy benefit manager (PBM). However, as business and client needs evolved, the focus shifted to building and deploying the next generation of electronic claims processing technology: Judi®, an open, secure, and scalable proprietary Enterprise Health Platform (EHP) capable of consolidating all benefit-related administrative workflows and connecting and exchanging data with any vendors that clients may choose. Leveraging its technology and a business model that aligns with employers' interests, Capital Rx has disrupted the traditional PBM... Show More
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
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
Transcarent

Transcarent

2.0 (1)
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Founded

2020

Employees

2,500

Funding Summary

126M Series D

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About Transcarent

Founded in 2020, Transcarent is a private health and care experience company aimed at simplifying access to high-quality, affordable care. Our integrated mobile and web platform offers a range of services, including everyday care such as instant provider consultations, behavioral health support, pharmacy services, home care, and comprehensive care for complex needs like surgery or cancer treatment.

What sets Transcarent apart is our commitment to accountability and transparency. We offer at-risk pricing models in which we assume financial responsibility for outcomes, with transparent impact reports that demonstrate measurable improvements in experience, health outcomes, and cost reduction. This... 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

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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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Founded

1993

Employees

0

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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RxSense

RxSense

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Founded

2015

Employees

0

Funding Summary

None

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About RxSense

RxSense is a health technology company, founded in 2015 – combining PBM industry veterans with industry-leading tech talent – that quickly became a leader in SaaS technology. In our PBM lives, we experienced, firsthand, the pain of being tied to antiquated, traditional PBM legacy systems, and we solved for these challenges in our enterprise platform solution, RxIQ® Enterprise, for pharmacy benefit administration and business intelligence.

With this unifying platform as a core and eliminating data friction, embedded with machine learning and AI-based automation, we have expanded our innovation in new directions to encompass a product spectrum with... Show More
VIVIO

VIVIO

5.0 (1)
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Founded

2016

Employees

0

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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
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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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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ClearScript

ClearScript

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Founded

2005

Employees

0

Funding Summary

None

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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
Health Action Council - CVS

Health Action Council - CVS

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Founded

09/1983

Employees

0

Funding Summary

Not Provided

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About Health Action Council - CVS

We recognize that a company’s employees are its greatest asset as well as its greatest liability in terms of the company’s success in the marketplace. Healthy employees are more productive and therefore able to contribute more to the success of their company and to the health of their communities. Health Action Council is a member-driven, not-for-profit organization . Our focus is on improving the relationship between business and health through thought leadership, innovative services, and collaboration. Our core business activities are Group Purchasing, Education and Health Improvement. Show More
Nomi Health

Nomi Health

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Founded

May 2019

Employees

0

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
ProCare Rx

ProCare Rx

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Founded

1988

Employees

400

Funding Summary

None

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About ProCare Rx

ProCare Rx, a privately-held, national leader in stand-alone pharmacy benefit management services, focused on pharmacy claims processing, and clinical program design, has empowered organizations since 1988. The primary goal is lowering net cost while improving patient health, by providing customizable, cost-effective solutions tailored to the unique needs of self-insured employer groups, TPAs, pharmacies, health plans/systems, unions, public sector, and other industry leaders. Our commitment to ethical, transparent operations and long-lasting partnerships has made us a trusted partner in optimizing pharmacy benefits and clinical performance. 
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SlateRx

SlateRx

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Founded

Employees

130

Funding Summary

Not Provided

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About SlateRx

SlateRx has been listening to what employers, plan sponsors, and brokers have been saying about traditional pharmacy benefit management—it’s time for something new. We provide a pharmacy benefit experience that puts you in control. Introducing PBX by SlateRx.

With deep actuarial, clinical, and operations experience, our ability to deliver results means unmatched value. With this proven expertise, we create innovative solutions that optimize medication access, improve health outcomes, and control costs. Our commitment to transparency and collaboration is at the core of our approach, ensuring clear communication and empowering informed decision-making.

We live... Show More
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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Surest

Surest

5.0 (1)
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Founded

2016

Employees

334

Funding Summary

Not Provided

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About Surest

Surest, a UnitedHealthcare company, is dedicated to redesigning health insurance, offering a simpler and more transparent way for people to access the health care system. Surest plans eliminate deductibles, feature up-front pricing for medical services before care is scheduled or delivered and an intuitive digital experience – all with the goal of lowering premiums without compromising coverage or quality. The company offers health plans to employers across the country, accessed through a national network of physicians and care professionals, as well as hospitals and other care facilities nationwide.

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UMR

UMR

4.2 (3)
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Founded

2008

Employees

3,800,000

Funding Summary

1 Corporate Round

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About UMR

UMR recommends the most advanced products and technologies for integration into the customer’s solutions.

UMR is a third-party administrator (TPA), hired by your employer, to help ensure that your claims are paid correctly so that your health care costs can be kept to a minimum and you can focus on well-being.

UMR is not an insurance company. Your employer pays the portion of your health care costs not paid by you. 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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