Abarca Health is an independent PBM built on its proprietary Darwin claims and benefits platform, managing roughly 7.5 million lives, 220 million claims, and about $14 billion in annual drug spend. It historically focused on health plans, Medicare and Medicaid, and in 2026 combined with employer-focused LucyRx under a common parent, Healthcare Revolution Partners, to serve employers, TPAs, unions, public-sector and government programs. Its Assura pricing offering provides net-cost-guarantee pricing intended to make drug spend more predictable and transparent.
- •Pricing model: Assura net-cost-guarantee pricing; positions as transparent alternative to legacy PBMs
- •Rebates: not_published
- •Ownership: wholly owned subsidiary of Healthcare Revolution Partners alongside LucyRx (combination completed Aug 2026)
- •Typical clients: regional and large health plans (e.g., Prominence Health), Medicare/Medicaid; employer market served via LucyRx
- •Scale: 7.5M lives, 220M claims/yr, $14B drug spend on Darwin platform; combined entity 9M+ members
- •HQ: San Juan, PR
AffirmedRx is a pharmacy benefit manager organized as a public benefit corporation and marketed on transparency to self-funded employers. It is URAC-accredited in pharmacy benefit management and sells primarily through the benefit advisor channel. Specific contract mechanics such as pass-through pricing and rebate treatment are not detailed on its public site.
- •Pricing model: marketed as transparent; specific pass-through terms not published
- •Rebates: not_published
- •Ownership: public benefit corporation (AffirmedRx, PBC), venture-backed and independent
- •Typical clients: self-funded employers
- •Accreditation: URAC accredited in Pharmacy Benefit Management through 06/01/2028
- •HQ: Louisville, KY; ranked No. 5 on the 2026 Inc. 5000
Alluma is a provider-led pharmacy benefit manager developed in collaboration between Vizient and Mayo Clinic, serving hospital and health systems and self-funded employers. Its revenue is structured to be independent of drug utilization, it does not own pharmacies, and it markets full transparency into cost drivers with rebates and savings passed to clients. Pharmacist-driven clinical programs and 340B reconciliation are core features for health-system clients.
- •Pricing model: revenue independent of utilization; zero hidden margins; transparent cost drivers
- •Rebates: rebates and savings passed through to clients (per company site)
- •Ownership: developed in collaboration between Vizient and Mayo Clinic
- •Typical clients: hospital and health systems, integrated providers, self-funded employers
- •Pharmacy: does not own pharmacies; network access of roughly 64,000 pharmacies
- •Founded: 2019, HQ: Irving, TX
Lives: 100 – no published max
BeneCard is a privately held prescription benefit administrator founded in 1990 that sells a fixed-cost, capitated pharmacy benefit: the plan sponsor pays a guaranteed maximum rate and BeneCard assumes financial liability beyond it, backed by aggregate excess-of-loss coverage from affiliated Heartland Fidelity Insurance Company. It serves private and public sector groups from roughly 100 to more than 5,000 members and dispenses through its own affiliated mail and specialty pharmacy, BeneCard Central Fill.
- •Pricing model: fixed-cost capitated PBM with a guaranteed maximum cost and no sponsor liability beyond it
- •Risk backing: aggregate excess-of-loss insurance from affiliated Heartland Fidelity Insurance Company (AM Best A-)
- •Rebates: not_published
- •Ownership: privately held, part of a family of companies including National Vision Administrators and Heartland Fidelity
- •Typical clients: private and public sector groups from about 100 to 5,000+ members
- •Founded: 1990, HQ: Lawrenceville, NJ; in-house mail and specialty dispensing via BeneCard Central Fill (Mechanicsburg, PA)
Citizens Rx is a privately held pharmacy benefit management company founded in 2009 and based in Oak Park, Illinois, serving plan sponsors with a focus on operational transparency, clinical expertise, and high-touch service. As of January 1, 2025 its pharmacy operations are powered by LucyRx.
- •Pricing model: markets operational transparency; specific terms not_published
- •Rebates: not_published
- •Ownership: privately held; pharmacy operations powered by LucyRx since Jan 1, 2025
- •Typical clients: plan sponsors (self-funded employers)
- •Founded: 2009, HQ: Oak Park, IL
ClearScript is a nonprofit pharmacy benefit manager owned by Fairview Health System, operating since 2005 and serving self-funded employers, TPAs, healthcare organizations, Tribal Nations, and public-sector plans nationwide. It offers pass-through pricing with no hidden fees, full claim-level reporting, and disclosure of all revenue streams including administrative fees, spread, and manufacturer-derived payments. Services include mail-service and specialty pharmacy, GLP-1 management, biosimilar strategies, and copay-assistance programs.
- •Pricing model: pass-through pricing, no hidden fees, full claim-level reporting and auditability
- •Rebates: discloses all revenue streams including manufacturer-derived payments and spread
- •Ownership: nonprofit; owned by Fairview Health System
- •Typical clients: self-funded employers, TPAs, healthcare organizations, Tribal Nations, public sector; carve-in or carve-out
- •Specialty pharmacy: mail-service and specialty pharmacy rooted in Fairview Specialty Pharmacy
- •Founded: 2005, HQ: Shoreview, MN
CVS Caremark is the pharmacy benefit management subsidiary of CVS Health and one of the three largest PBMs in the United States, which together handle roughly 80% of US prescription claims. It serves health plans, employers and government programs with formulary management, claims processing, plan design and administration, mail order pharmacy and specialty pharmacy and infusion services, and processed about 1.9 billion 30-day equivalent claims in 2024. Alongside its traditional rebate-based contracts it offers TrueCost, a model introduced in 2023 that prices at the net cost of medication with separately disclosed administrative fees.
- •Pricing model: traditional rebate-based contracting, plus the TrueCost net-cost model introduced in 2023
- •Rebates: negotiated with manufacturers; sharing terms vary by contract and are not published
- •Ownership: subsidiary of CVS Health Corporation
- •Typical clients: health plans, large employers and government programs, including CalPERS (587,000 members, announced July 2025)
- •Specialty pharmacy: yes, plus infusion services and CVS Caremark mail service
- •Scale: about 1.9 billion 30-day equivalent PBM claims in 2024; one of three PBMs handling roughly 80% of US claims
Drexi is a pharmacy benefit manager operating under Advanced Medical Pricing Solutions (AMPS) that markets an honest-pricing model in which pharmacies compete on price for the plan's business. It serves self-funded employer plans alongside the AMPS reference-based pricing and medical cost containment products, and provides prior authorization, direct member reimbursement, mail order and enrollment services. Its published materials do not detail administrative fee or rebate terms.
- •Pricing model: markets pure honest pricing with pharmacies competing for the plan's business; terms not published
- •Rebates: not_published
- •Ownership: operates under Advanced Medical Pricing Solutions (AMPS)
- •Typical clients: self-funded employer plans, frequently paired with AMPS reference-based pricing
- •Services: prior authorization, direct member reimbursement, mail order, enrollment support
Express Scripts is one of the three largest US pharmacy benefit managers, founded in 1986 in the St. Louis area and operating since 2018 as a subsidiary of The Cigna Group under the Evernorth brand. It provides network claims processing, home delivery through Express Scripts Pharmacy, specialty pharmacy through Accredo, and formulary and clinical management for health plans, employers and self-funded organizations including the Department of Defense TRICARE program. Its current employer offering is marketed on automatically applying the lowest available price at the counter, including cash and manufacturer prices, and on independently validated pharmacy reimbursement.
- •Pricing model: traditional PBM contracting, plus a marketed lowest-available-price-at-counter option with independently validated pharmacy reimbursement
- •Rebates: negotiated with manufacturers; sharing terms vary by contract and are not published
- •Ownership: subsidiary of The Cigna Group, branded under Evernorth Health Services since 2020
- •Typical clients: health plans, large employers and self-funded organizations; administers TRICARE for the Department of Defense
- •Specialty pharmacy: Accredo; mail order via Express Scripts Pharmacy
- •Founded: 1986, HQ: St. Louis, MO
FairosRx is a pharmacy benefit manager based in Amarillo, TX, operated as a division of The OccuNet Company, that markets a true pass-through model with a concise 10-page contract and no hidden fees. It contracts with employer groups, brokers and consultants to administer prescription benefits, providing real-time claims data, formulary and utilization management, copay assistance programs, a GLP-1 obesity program, and home delivery through a network of more than 63,000 pharmacies.
- •Pricing model: true pass-through, no hidden fees, 10-page contract
- •Ownership: division of The OccuNet Company (Amarillo, TX)
- •Typical clients: employer groups, brokers and consultants
- •Network: 63,000+ retail pharmacies nationwide plus home delivery
- •Clinical programs: GLP-1 obesity program, copay assistance, utilization management
- •HQ: Amarillo, TX
Judi Rx, formerly Capital Rx, is the full-service pass-through pharmacy benefit management arm of Judi Health, a New York-based health benefits technology company built on its proprietary Judi adjudication platform. It uses a flat-fee pricing model that eliminates traditional rebate-driven economics, serves self-funded employers, municipalities, unions, hospitals, health systems, health plans and TPAs with more than 5 million contracted PBM lives, and also offers Judi Equilibrium, a level-funded pharmacy benefit program.
- •Pricing model: flat-fee, pass-through pharmacy benefit administration
- •Rebates: pass-through; flat-fee model eliminates traditional rebate structures
- •Ownership: venture-backed (Wellington Management, General Catalyst); $400M raised September 2025
- •Typical clients: self-funded employers, unions, municipalities, health systems, health plans and TPAs
- •Level-funded: Judi Equilibrium level-funded pharmacy benefit program
- •Scale: 5M+ contracted PBM lives; HQ: New York, NY
Liviniti, founded in 2011 as Southern Scripts and renamed in May 2023, is a national transparent pass-through pharmacy benefit manager headquartered in Natchitoches, LA, with private-equity backing from Water Street Healthcare Partners. Employers pay exactly what Liviniti pays the pharmacy plus a flat, all-inclusive administrative fee, receive 100% of rebates and discounts, and are never required to use PBM-owned mail or specialty pharmacies; the company serves more than 750,000 plan members and offers the LivLite GLP-1 weight-loss management program.
- •Pricing model: pass-through; flat, all-inclusive administrative fee for standard services
- •Rebates: 100% of rebates and discounts returned to the employer
- •Ownership: private; Water Street Healthcare Partners investment (2020); CEO and co-founder LeAnn C. Boyd, PharmD
- •Typical clients: local, regional and national self-funded employers; 750,000+ plan members; used by Allied National level-funded and self-funded plans
- •Specialty pharmacy: does not mandate use of owned mail or specialty pharmacies
- •Founded: 2011 (as Southern Scripts), HQ: Natchitoches, LA; renamed Liviniti 2023
LucyRx is an independent pharmacy benefit manager marketed on transparent pricing and alignment with plan sponsors. It serves employers, TPAs, labor unions, public-sector plans, health systems, health plans and government programs, and runs claims on the Darwin platform with a proprietary LucyIQ analytics tool and Care Guide member support. The company reports more than 4,000 clients and a 60,000-plus pharmacy network.
- •Pricing model: marketed as transparent; contract terms not published
- •Rebates: not_published
- •Ownership: independent PBM; combined with Abarca Health under Healthcare Revolution Partners (Aug 2026)
- •Typical clients: employers, TPAs, unions, public sector, health plans (4,000+ clients)
- •Specialty pharmacy: not_published
- •Founded: 2023, HQ: Bethesda, MD
MedImpact is a large privately held, independent pharmacy benefit manager headquartered in San Diego that administers pharmacy benefits for health plans, employers, TPAs and government programs. It is URAC accredited in pharmacy benefit management and NCQA certified, and offers home delivery and specialty medication access alongside standard network and clinical services. Its distinguishing historical position is independence from a retail pharmacy chain or insurer, though its published materials do not detail pricing or rebate terms.
- •Pricing model: not_published
- •Rebates: not_published
- •Ownership: privately held and independent of a retail chain or health insurer
- •Typical clients: health plans, employers and government programs, often accessed through TPAs
- •Accreditation: URAC Pharmacy Benefit Management through 03/01/2029; NCQA certified
- •HQ: San Diego, CA; Southwest regional operations center in Tempe, AZ; international offices in Abu Dhabi and Beijing
MedOne Pharmacy Benefit Solutions is a family-founded and owned, 100% pass-through pharmacy benefit manager established in 1999 by pharmacist Richard Hartig of Hartig Drug Company and headquartered in Dubuque, IA. It serves self-funded employers of all sizes in all 50 states (more than 260 clients), owns all core PBM functions in-house including claims processing, pharmacy contracting and formulary management, and operates its own cost-plus specialty and mail-order pharmacy.
- •Pricing model: 100% pass-through, fully transparent, guaranteed savings
- •Rebates: all rebates and upside passed to clients
- •Ownership: family-founded and owned since 1999 (Hartig family, Hartig Drug Company)
- •Typical clients: 260+ self-funded employers of all sizes in all 50 states; preferred PBM partner of Gateway Business Health Coalition (2026)
- •Specialty pharmacy: in-house cost-plus specialty and mail-order pharmacy (MedOne Pharmacy Services, Dubuque)
- •Founded: 1999, HQ: Dubuque, IA; 2024 Inc. 5000 honoree
Navitus Health Solutions is a fully transparent, 100% pass-through pharmacy benefit manager founded in 2003 and headquartered in Madison, WI, co-owned by SSM Health and Costco Wholesale. It serves employers, health plans, government programs and unions across all 50 states with roughly 18 million members among about 800 clients, charging an administrative fee and returning all rebates and manufacturer discounts to clients, with cost-plus specialty pharmacy through its Lumicera subsidiary and a mid-market offering through EpiphanyRx.
- •Pricing model: 100% pass-through with administrative fee only
- •Rebates: all rebates and manufacturer discounts passed directly to clients
- •Ownership: SSM Health (majority) and Costco Wholesale (minority stake since 2020)
- •Typical clients: employers, health plans, state/government programs, unions; ~800 clients and ~18M members in all 50 states
- •Specialty pharmacy: Lumicera Health Services cost-plus specialty pharmacy
- •Founded: 2003, HQ: Madison, WI
Optum Rx is the pharmacy benefit management business of Optum, a UnitedHealth Group company, and one of the three largest PBMs in the U.S., serving roughly 61-62 million people. It historically operates a traditional, scale-based model with negotiated pricing guarantees, its own home delivery and specialty pharmacies, and mail and specialty networks; in 2026 it announced a transparent, fee-based pharmacy care model with monthly per-member fees and a commitment to pass through 100% of manufacturer rebates to clients by January 1, 2028.
- •Pricing model: traditional negotiated guarantees; transitioning to fee-based per-member pricing with 100% rebate pass-through by 2028
- •Rebates: 100% pass-through committed to all clients by January 1, 2028
- •Ownership: UnitedHealth Group (Optum)
- •Typical clients: large employers, health plans, state and public sector plans, coalitions
- •Specialty pharmacy: owned specialty and home delivery pharmacies; mail and specialty networks
- •Scale: about 61-62 million people served
Prescryptive Health is a healthcare technology company founded in 2017 by former Microsoft cloud engineers that operates a pharmacy benefit business alongside a direct-access prescription marketplace. It sells to employers and their consultants, independent pharmacies, health systems and manufacturers, and differentiates on member-facing technology including its myPrescryptive mobile experience, real-time price transparency at the point of prescribing, and AI-based cash-price optimization for pharmacies. Contract pricing and rebate terms are not published.
- •Pricing model: marketed on price transparency at the point of prescribing; contract terms not published
- •Rebates: not_published
- •Ownership: independent; co-founded by Microsoft cloud veterans
- •Typical clients: employers and consultants, independent pharmacies, health systems, pharmaceutical manufacturers
- •Technology: myPrescryptive member app, EHR integration, digital medicine cabinet, AI cash-price optimization for pharmacies
- •Founded: 2017
Prime Therapeutics is a privately held pharmacy benefit manager founded in 1998 and owned by a group of Blue Cross and Blue Shield plans, serving health plans, employers, consultants, government programs and unions. It operates home delivery and specialty pharmacy services with more than 7,000 employees, and markets itself as transparent on the grounds that it does not steer members to its own pharmacies. Contract-level pricing and rebate terms are not published.
- •Pricing model: not_published; states it does not steer members to its own pharmacies
- •Rebates: not_published
- •Ownership: privately held, owned by Blue Cross and Blue Shield plan partners
- •Typical clients: health plans, employers, consultants, government programs and unions
- •Specialty pharmacy: yes, plus home delivery; 7,000+ employees
- •Founded: 1998, HQ: Eagan, MN
ProAct is a pharmacy benefit manager and third-party administrator that describes itself as the largest employee-owned PBM in the United States. It sells to employer groups, unions and government plans both directly and through a national TPA network, and operates its own mail order pharmacy in Gouverneur, NY along with retail network, specialty and prior-authorization services. Its published pricing and rebate terms are not disclosed on its public site.
- •Pricing model: not_published
- •Rebates: not_published
- •Ownership: employee-owned; markets itself as the largest employee-owned PBM in the country
- •Typical clients: employer groups, unions and government plans, sold directly and through a national TPA network
- •Mail order: ProAct mail order pharmacy, 1226 US Highway 11, Gouverneur, NY 13642
- •Also offers specialty pharmacy, retail network and prior authorization; 24/7/365 member help desk
Rightway is a New York-based care navigation and pharmacy benefits company whose PBM operates on a 100% pass-through model funded by a single flat administrative fee, with all rebates and discounts returned to the plan and no spread pricing or pharmacy ownership. It serves self-funded employers, often bundling pharmacy benefits with its clinician-led care navigation, and in January 2026 introduced SureSpend, a guaranteed monthly drug-spend model that refunds 100% of overages.
- •Pricing model: single flat admin fee, no spread pricing; SureSpend guaranteed monthly cost with 100% refund of overages (launched Jan 2026)
- •Rebates: 100% pass-through to the plan
- •Ownership: privately held, venture-backed; co-founded by CEO Jordan Feldman and Dr. Theodore Feldman
- •Typical clients: self-funded employers including Genentech, Eli Lilly, Tyson Foods, Zoom, TikTok
- •Specialty pharmacy: no owned pharmacies; formulary built on lowest net cost
- •HQ: New York, NY
RxBenefits describes itself as a pharmacy benefits optimizer rather than a PBM: it aggregates self-funded employer groups to buy PBM contracts at coalition-scale pricing and layers on independent clinical management, prior authorization review and account service. It is sold almost exclusively through benefit advisors and consultants and serves employers, health systems, labor and trust funds, private-equity portfolio companies, TPAs and multi-employer groups. The company states it is compensated on a flat fee rather than on rebates or spread.
- •Pricing model: flat-fee compensation; company states it is not paid from rebates or spread
- •Category: pharmacy benefits optimizer (PBO) that contracts on behalf of employers with large PBMs, not a claims-adjudicating PBM
- •Typical clients: self-funded employers, health systems, labor and trust funds, PE-backed companies, TPAs and multi-employer groups
- •Distribution: sold through benefit advisors and consultants
- •Clinical: independent clinical management and prior authorization review, reported $17-$22 PMPM savings
Sav-Rx is a family-founded, union-focused pharmacy benefit manager that administers self-funded prescription benefits for union health and welfare funds, private employers, and municipalities. In 2022 it introduced a fully transparent pass-through pricing model benchmarked to NADAC for retail and mail, and it operates its own mail-order pharmacy in Fremont, Nebraska. In 2025 it agreed to join MedImpact while continuing to operate under its own brand and leadership.
- •Pricing model: NADAC-based transparent pass-through for retail and mail (introduced 2022)
- •Rebates: not_published
- •Ownership: family-founded; agreed to be acquired by MedImpact (announced Sept 2025), continues operating in Fremont, NE under existing leadership
- •Typical clients: Taft-Hartley union funds (Bricklayers, Iron Workers), private employers, municipalities; 1,000+ clients, 10M+ covered lives
- •Mail order: owns centralized mail-order pharmacy in Fremont; point-of-care dispensing via A-S Medication Solutions
- •Founded: 1969, HQ: Fremont, NE
Serve You Rx (legal name Serve You Custom Prescription Management, Inc.) is an independent, privately held full-service pharmacy benefit manager founded by pharmacists in Milwaukee, WI in 1987. It focuses on self-funded, mid-market employer groups along with Taft-Hartley funds, TPAs, municipalities, tribal nations, health systems, coalitions and captives, offering explicit pass-through pricing, 100% rebate pass-through, plan sponsor data ownership, and its own home delivery and specialty pharmacy operations.
- •Pricing model: explicit pass-through pricing; Fiduciary Alignment Score 93 (Excellent) in CAA 2026 Readiness Report
- •Rebates: 100% rebate pass-through
- •Ownership: independent, privately held since 1987; founding pharmacists retain ownership
- •Typical clients: self-funded mid-market employers, Taft-Hartley funds, TPAs, public sector, captives; implementations in 30 days or less
- •Specialty pharmacy: owned home delivery (Serve You DirectRx, URAC-accredited mail service) and specialty pharmacy
- •Founded: 1987, HQ: Milwaukee, WI; 2026 Inc. 5000 honoree
SmithRx is a transparent, pass-through pharmacy benefit manager for self-insured employers, operating independently of insurers and pharmacies. It charges a flat per-member-per-month administrative fee, passes through 100% of manufacturer rebates and discounts, and evaluates drugs on net cost, with sourcing partnerships such as Mark Cuban Cost Plus Drug Company; offices are in San Francisco, CA, Lehi, UT and Plano, TX.
- •Pricing model: flat per-member-per-month administrative fee, no spread
- •Rebates: 100% pass-through of rebates and discounts
- •Ownership: privately held, venture-backed (Smith Health, Inc.); founder/CEO Jake Frenz
- •Typical clients: self-insured employers and TPAs, reported 20% lower PMPM than industry benchmark
- •Specialty pharmacy: no owned pharmacy; Cost Plus Drugs sourcing partnership
- •Founded: 2016, HQ: San Francisco, CA
TransparentRx is a pharmacy benefits administrator that markets a fiduciary model to self-funded employers, brokers and TPAs, positioning itself against spread pricing and retained rebates. It performs claims adjudication, eligibility, plan configuration, prior authorization administration and reporting, and also sells a specialty drug management service. Its specific per-claim administrative fee and rebate pass-through terms are quoted rather than published.
- •Pricing model: fiduciary pharmacy benefits administration; states it removes spread pricing, specific fee quoted on request
- •Rebates: states clients regain control of rebates; percentage not published
- •Category: pharmacy benefits administrator (PBA) rather than traditional PBM
- •Typical clients: self-funded employers, brokers and TPAs
- •Services: claims adjudication, eligibility, plan configuration, prior authorization, reporting, specialty drug management
- •HQ: Las Vegas, NV
TrueScripts Management Services is a pharmacist-founded, privately held prescription benefit manager that describes its model as fully transparent and conflict-free. It serves self-funded employers, plan sponsors and partnered health plans through broker and advisor channels, and offers clinical programs including the PrecisionCare+ pharmacogenomics program, prior authorization turnaround of 24-48 hours, and live-answer member service.
- •Pricing model: fully transparent, conflict-free PBM (company description)
- •Ownership: privately held, pharmacist-founded
- •Typical clients: self-funded employers and plan sponsors via brokers/advisors
- •Clinical programs: PrecisionCare+ pharmacogenomics testing with PGx-certified pharmacists
- •Founded: 2014, HQ: Washington, IN
- •Company size: 51-200 employees; Best Places to Work in Indiana 2023
US-Rx Care is a pharmacy benefit manager that markets itself as fiduciary and transparent, positioning its compensation as independent of drug spend. It serves self-insured employers, health plans, union health and welfare funds, and the benefit advisors that place them, and its contractual integrity, transparency and savings claims have been reviewed by the Validation Institute. Specific pricing and rebate terms are not published on its public site.
- •Pricing model: markets a fiduciary, transparent PBM model; contract terms not published
- •Rebates: not_published
- •Typical clients: self-insured employers, health plans, union health and welfare funds, benefit advisors
- •Validation: independently reviewed by the Validation Institute for contractual integrity, transparency and savings
- •Experience: states more than 30 years managing pharmacy risk
Ventegra is a California nonprofit public benefit corporation and certified B Corporation that provides pharmacy and medical benefit management services, describing its role as broader than traditional pharmacy benefit management. It serves health systems, self-insured employers, TPAs, medical groups, brokers and consultants, government entities and nonprofits, and markets transparent cost management aligned to its nonprofit mission. Specific contract pricing and rebate terms are not published.
- •Pricing model: markets transparent cost management; specific terms not published
- •Rebates: not_published
- •Ownership: California nonprofit public benefit corporation; certified B Corporation
- •Typical clients: health systems, self-insured employers, TPAs, medical groups, brokers, government entities, nonprofits
- •Scope: positions itself as a medical benefit manager operating beyond traditional PBM services
- •HQ: Glendale, CA
Vivid Clear Rx is a transparent pharmacy benefit manager launched in December 2020 as a subsidiary of Iowa grocery and pharmacy retailer Hy-Vee, Inc. It charges a fixed per-member-per-month management fee, passes rebates and discounts back to clients with no spread pricing, and serves more than 200 employer groups nationwide on RxSense's RxAgile platform, with mail order and access to sister company Amber Specialty Pharmacy.
- •Pricing model: fixed per-member-per-month fee, no spread pricing
- •Rebates: 100% of rebates, discounts and savings passed back to the employer
- •Ownership: subsidiary of Hy-Vee, Inc. (West Des Moines, IA)
- •Typical clients: 200+ employer groups, plus Hy-Vee's own 88,000+ employees
- •Specialty pharmacy: sister company Amber Specialty Pharmacy; mail order available
- •Founded: 2020, HQ: Omaha, NE (parent Hy-Vee in West Des Moines, IA)
VytlOne is the pharmacy benefit management business of Maxor National Pharmacy Services, rebranded from MaxorPlus. It is a full-service independent PBM with more than 30 years in the market covering over 10 million lives across employers, health plans, TPAs, coalitions and government programs, and it operates its own URAC-accredited mail order and specialty pharmacies. The company markets a single consolidated view of mail, specialty, clinical services, pricing and rebates.
- •Pricing model: not_published; markets transparency across pricing, purchasing and rebates
- •Rebates: not_published
- •Ownership: business unit of Maxor National Pharmacy Services
- •Typical clients: employers, health plans, TPAs, coalitions and government programs; over 10 million lives
- •Specialty pharmacy: yes, URAC accredited; mail order also URAC accredited
- •Operations: call centers in TX and AZ; mail and specialty pharmacies in GA, NV and TX
WellDyne is an independent, privately held full-service pharmacy benefit manager that markets itself on transparency and clinical programs. It serves employers, unions, TPAs, hospital and health systems, state and local governments, and health plans, with a stated focus on the middle market through consultants and brokers. Mail order, central fill, and specialty pharmacy services are delivered through its HealthDyne pharmacy operating unit.
- •Pricing model: markets transparency to plan sponsors; specific pass-through vs. traditional terms not published
- •Rebates: not_published
- •Ownership: privately held, independent PBM
- •Typical clients: employers, unions, TPAs, health systems, public sector, health plans; middle-market focus via brokers/consultants
- •Specialty pharmacy: mail order, central fill and specialty pharmacy via HealthDyne unit
- •Founded: 1990, HQ: Lakeland, FL (second office Centennial, CO)
