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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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
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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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
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
Exouza

Exouza

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Founded

2019

Employees

Funding Summary

Not Provided

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About Exouza

Exouza was founded by health and technology industry experts to leverage modern technology to develop a single platform that maximizes the value of member benefits to integrate all available programs in a single platform that quickly and efficiently improves the process of managing health and Rx delivery. Exouza's technology quantifies the value from each member's eligible program, sequences engagement in prioritized order, and manages participation so that the member and employer achieve maximum value. Each member and drug experience is different which makes the Exouza solution unique. Savings service and value are guaranteed.
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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
Independence Blue Cross (IBX)

Independence Blue Cross (IBX)

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Not Provided

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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
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
OptumRx

OptumRx

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Founded

1989

Employees

243

Funding Summary

Not Provided

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About OptumRx

Since our inception in 1989, we have worked closely with our customers to provide high-quality pharmacy care services designed to promote optimized care. We manage over two billion pharmacy claims annually and serve more than 62 million members across a broad spectrum of customers, including public and government entities, health plans, Medicare and Medicaid plan sponsors, employer groups, collective bargaining groups and third-party administrators. We are more than a pharmacy benefit manager—we are a pharmacy care services company focused on driving transformative change and delivering quality holistic care. Show More
Serve You Rx

Serve You Rx

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Founded

1987

Employees

Funding Summary

None

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About Serve You Rx

Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for over 36 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client... Show More
US-Rx Care

US-Rx Care

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Founded

01/2007

Employees

200

Funding Summary

Not Provided

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About US-Rx Care

In contrast to traditional PBM service providers, US-Rx Care operates with full transparency and without any conflicts of interest, backed up by ERISA-defined fiduciary commitments in our service contract. Our fiduciary pharmacy benefits management services deliver unprecedented drug cost savings to self-insured employers, union trusts, and health plans. Typical client savings range from 30%-50% in total drug and administrative cost versus their previous PBM service provider within the first 12 months of US-Rx Care service. Member out-of-pocket costs drop 30% or more also with no change in benefit design. Show More
VIVIO

VIVIO

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Founded

2016

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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
WellDyne

WellDyne

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Founded

1990

Employees

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
Abarca Health

Abarca Health

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Founded

2005

Employees

Funding Summary

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
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
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
ClearScript

ClearScript

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Founded

2005

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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

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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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