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PBM Directory

AffirmedRx

Founder/CEO

Greg Baker, founder and CEO

Date founded

March 2021

Number of employees

100

Description

A public benefit corporation that partners with employers, health plans, hospital systems; charges flat administration fee and has a pass-through pricing model.

Formulary

Yes. Prioritizes biosimilars and generics

Transparency efforts

Clients have access to all claims and financial data; unrestricted access to data

CVS Caremark

Founder/CEO

Group President, Prem Shah Ed DeVaney, President of CVS Caremark

Date founded

CVS acquired Caremark in 2007

Number of employees

More than 300,000

Description

Uses an integrated model

Formulary

Plan sponsors can choose approach; the PBM has option to move away from rebate-dependent formulary

Transparency efforts

New programs include: CVS CostVantage and CVS Caremark TrueCost

EmpiRx Health

Founder/CEO

Bill Resnick, founder; Danny Sanchez, CEO

Date founded

2014

Number of employees

325

Description

A pharmacist-led PBM model that focuses on value and on improving patient health outcomes

Formulary

Open formulary developed and managed by company's P&T committee.

Transparency efforts

Provides a Clinical Savings Guarantee, which identifies and tracks opportunities for savings

Liviniti (formerly Southern Scripts)

Founder/CEO

Founders LeAnn Boyd and Steven T. Boyd

Date founded

April 2011

Number of employees

450

Description

Serves self insured employers, unions, hospitals, TPAs, state and local governments

Formulary

Yes. Focused on lowest net cost; 100% pass through rebates

Transparency efforts

Rebate details, network contracts and audit information available for client review

LucyRx

Founder/CEO

CEO David Blair

Date founded

2023

Number of employees

200

Description

Independent, fee-based fiduciary PBM serving self-insured employers

Formulary

No fixed formulary; will customize for each client

Transparency efforts

Provide real-time insights that support evidence-based clinical decisions and clear pricing

MedImpact Healthcare Systems Inc.

Date founded

1989

Number of employees

More than 2,000

Description

Clients can choose a fully managed end-to-end program, a self-service bundle, or from an array of best-in-class services, solutions, and technologies to meet their needs

Formulary

Offers a suite of formulary options, all of which are designed to provide payers flexibility and low net costs

Transparency efforts

Technology that gives payers real-time insights into care and costs

Navitus Health Solutions

Founder/CEO

Robert Palmer, founder; David Fields, CEO

Date founded

2003

Number of employees

2,050

Description

Passes 100% of rebates and discounts on to plan sponsors and health plans

Formulary

yes

Transparency efforts

Clients have full access to their data, down to the individual claim level.

Prime Therapeutics

Founder/CEO

Blue Plans in North Dakota, Wyoming and Kansas; Mostafa Kamal, CEO

Date founded

1998

Number of employees

7,400

Description

Provides transparent solutions for pharmacy benefit management, specialty and medical drug management, and state government solutions

Formulary

Yes. P&T committee recommends which drugs are placed on drug benefit formulary.

Transparency efforts

Doesn’t steer people to own pharmacies or pursue the highest margins

Rightway

Founder/CEO

Jordan Feldman, Dr. Ted Feldman

Date founded

2017

Number of employees

About 500

Description

Transparent PBM supported by care navigation

Formulary

Offers a clinically-led, cost-optimized formulary that supports better health outcomes; managed by company's own P&T committee

Transparency efforts

Disclose all revenue, including any manufacturer payments, and 100% pass through of rebates; full visibility into drug costs, utilization, and performance, no black boxes, no hidden fees.

RxBenefits Inc.

Founder/CEO

Bill Gunnells, founder; Robert Gamble, CEO

Date founded

1995

Number of employees

More than 1,000

Description

Focused on self-funded plans with an independent and flexible approach; flat-fee based

Formulary

Tailored options; new program Illuminate Rx provides formulary options, including specialty generics and biosimilar focused formulary and customizable open formulary

Transparency efforts

Provides flat fees, data and shared insights, along with advocacy for long-term cost containment.

Serve You Rx

Founder/CEO

Justin Jasniewski, CEO

Date founded

1987

Number of employees

103

Description

Full-service PBM with flexibility offerings; clinical programs focus on lowest net cost and trend management; pass-through contract model

Formulary

Three formulary options managed by a P&T committee

Transparency efforts

Pass-through contract model validated by The Validation Institute; no hidden spread pricing; precise contract definitions; robust data access and audit provisions

SmithRx

Founder/CEO

Jake Frenz, founder and CEO

Date founded

2016

Number of employees

530

Description

Full-service PBM with pass-through pricing and savings programs for self-insured businesses; flat fee-based with a model centered on fiduciary alignment

Formulary

Yes

Transparency efforts

Clients can access detailed claim and pricing information, fees, and rebate arrangements

Ventegra Foundation

Founder/CEO

Robert T. Taketomo, Pharm.D., founder and CEO

Date founded

2004

Number of employees

200

Description

Provides integrated medical/pharmacy benefit administration

Formulary

Yes

Transparency efforts

Transparency on claims data and costs (include discounts and rebates; has a 90-day “no cause” termination

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