Pharmacy benefit managers (PBMs) play a major role in the provision of pharmacy services by acting as intermediaries between pharmacies, plan sponsors (insurance companies and employers), pharmaceutical manufacturers, and drug wholesalers.
The market for PBM services is highly concentrated, with the top three firms (CVS Health/Caremark, Cigna (Evernorth/Express Scripts, and UnitedHealth (OptumRx) controlling an estimated nearly 80% of the market.
PBMs can influence a significant portion of the cost of drugs. Lack of price transparency for employers in many PBM contracts have led many stakeholders to question how they function, what deals they make, how they generate revenue, and what specific services they perform.
As the role of and visibility have increased, PBMs have come under increased scrutiny from policy makers for their role in drug pricing discussions.
Pharmacy benefit managers are also encountering competition from new pharmacy players, such as Mark Cuban Cost Plus Drugs, and a number of other companies that AMI profiles as non-traditional market participants in the report.
Many of these companies are promoting transparency in their pricing models in which they pass 100% of the discounts they receive from pharmacies and pharmaceutical companies to the health plan/employer sponsor.
The 2024-2025 PBM Review (210 pages) offers comprehensive intelligence on nearly 70 PBM companies. The report identifies and segments the market into Market Leaders, Mid-Market PBMs, and Non-Traditional PBMs. AMI’s complementary report, PBM Platform Companies 2024-2025 Review, will be published in June 2024.
Each PBM company profile includes: company background, strategy, key decision-makers, financial/investor information, products and services, and recent activities.
AMI continues to monitor and report on the pharmaceutical benefit management market on a continuing basis and works with clients on a custom research basis to provide the market intelligence they need to be successful.
Table of Contents
PBM Market
- Introduction – pgs. 5-6
PBM Market Leader Company Profiles
- Evernorth Express Scripts/The Cigna Group – pgs. 8-16
- CVS Health/Caremark – pgs. 17-23
- OptumRx/UnitedHealth Group – pgs. 24-27
- Prime Therapeutics – pgs. 28-31
- CenterWell Pharmacy/Humana – pgs. 32-35
- MedImpact/Elixir Solutions – pgs. 36-40
- Envolve Pharmacy Solutions/Centene – pgs. 41-44
- PerformRx – pgs. 45-46
- CarelonRx/Elevance Health – pgs. 47-51
Mid-Market PBM Company Profiles
- Abarca Health – pgs. 53-55
- Araya Pharmacy Benefit Management – pgs. 56-57
- BeneCard PBF – pgs. 58-59
- Costco Health Solutions – pgs. 60-61
- EHIM, Inc. – pgs. 62-64
- HealthSmartRx Solutions – pgs. 65-66
- Integrated Prescription Management – pgs. 67-68
- Kroger Prescription Plans – pgs. 69-71
- MaxorPlus – pgs. 72-74
- MC-Rx – pgs. 75-77
- Navitus Health Solutions – pgs. 78-80
- Paramount Rx – pgs. 81-82
- PCA Rx – pgs. 83-84
- Pharmacy Benefit Dimensions – pgs. 85-87
- Pharmacy Data Management, Inc. – pgs. 88-89
- ProAct PBM – pgs. 90-93
- Sav-Rx Prescription Services – pgs. 94-96
- Scripius/Select Health – pgs. 97-98
- Script Care, Ltd. – pgs. 99-101
- ScriptGuideRx – pgs. 102-104
- Serve You Rx – pgs. 105-108
- US-Rx Care – pgs. 109-111
- Ventegra – pgs. 112-114
- WellDyne – pgs. 115-118
Non Traditional PBM Company Profiles
- Advanced Medical Pricing Solutions/Drexi – pgs. 120-122
- AffirmedRx, PBC – pgs. 123-124
- Alluma, LLC – pgs. 125-126
- Capital Rx – pgs. 127-130
- CerpassRx – pgs. 131-133
- CitizensRx – pgs. 134-136
- ClearScript – pgs. 137-138
- DisclosedRx – pgs. 139-140
- EmpiRx Health – pgs. 141-143
- FairosRx, LLC – pgs. 144-145
- Goodroot Inc./AlignRx – pgs. 146-149
- Liviniti – pgs. 150-152
- LucyRx – pgs. 153-155
- MakoRx Complete Care – pgs. 156-158
- MaxCareRx – pgs. 159-161
- MedalistRx – pgs. 162-163
- MedOne – pgs. 164-165
- PharmAvail Benefit – pgs. 166-167
- Phoenix Benefit Management – pgs. 168-169
- Rightway Healthcare – pgs. 170-174
- RxParadigm – pgs. 175-177
- RxPreferred – pgs. 178-180
- SmithRx – pgs. 181-184
- TandemRx – pgs. 185-186
- Transcarent – pgs. 187-189
- TransparentRx – pgs. 190-191
- True Rx Health Strategists – pgs. 192-193
- TrueScripts Management Services – pgs. 194-196
- Trust Scripts – pgs. 197-198
- VativoRx – pgs. 199-210
- VeracityRx – pgs. 202-204
- VerusRx – pgs. 205-206
- Vivid Clear Rx/Hy-Vee – pgs. 207-208
- WithMe Health – pgs. 209-210