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
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
Transcarent

Transcarent

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Founded

2020

Employees

409

Funding Summary

4.5M 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
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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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
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
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
RxSense

RxSense

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Founded

2015

Employees

381

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
Alluma

Alluma

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Founded

2019

Employees

222

Funding Summary

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
AmWINS Rx

AmWINS Rx

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Founded

2006

Employees

0

Funding Summary

Not Provided

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About AmWINS Rx

AmWINS Rx provides consultative pharmacy benefit management services that equip members with the information and advocacy needed to make informed decisions that ultimately improve member health and maximize plan savings. Show More
Archimedes

Archimedes

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Founded

2016

Employees

0

Funding Summary

Not Provided

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About Archimedes

Specialty drug spend is the single fastest growing healthcare expense. Recognizing the potential clinical value of these drugs, plan sponsors want to provide them to their enrollees—but to maintain an affordable, sustainable benefit in this rapidly changing environment, they must also control costs. To do this, plan sponsors need quantitative information about which strategies work to target drugs to those in need of them and they must minimize use of clinically ineffective therapies and reduce waste. However, the guidance and services provided to plan sponsors to achieve these goals is not always objective or complete.

Recognizing... 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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Capital Rx

Capital Rx

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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
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
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

0

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
PharmPix Corp

PharmPix Corp

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Founded

2009

Employees

150

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
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
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
Walgreens

Walgreens

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Founded

1901

Employees

0

Funding Summary

Not Provided

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About Walgreens

Walgreens is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), a global leader in retail and wholesale pharmacy. As America’s most loved pharmacy, health and beauty company, Walgreens purpose is to champion the health and wellbeing of every community in America. Operating more than 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, Walgreens is proud to be a neighborhood health destination serving approximately 8 million customers each day. Walgreens pharmacists play a critical role in the U.S. healthcare system by providing a wide range of pharmacy and healthcare services. To... 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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