Amy Wadstrom, RPh, on mid-size PBMs and leaving the ‘big three’ | PBMI 2026

Amy Wadstrom, RPh, president of Vivid Clear Rx, acknowledged that choosing a pharmacy benefit manager other than one of the industry’s big three — Optum Rx, CVS Caremark and Express Script — is a frightening prospect for many employers and plan sponsors. Making the switch, she said, takes a willingness to trust a smaller organization with that they aren’t familiar with.

“I think employers have to be brave,” said Amy Wadstrom, RPh.

Wadstrom participated in a panel yesterday called “Redefining the Future of Pharmacy Care" that kicked off the two-day 2026 Pharmacy Benefit Management Institute Annual National Conference in Orlando, Florida. She spoke with Managed Healthcare Executive (MHE) after the panel discussion. MHE and the PBMI meeting share a common owner, MJH Life Sciences in Cranbury, New Jersey. The other panelists were Kathryn Carey, MBA, president of PBM at Optum; Dana McCormick, RPh, vice president of practice innovation at the Academy of Managed Care Pharmacy; Krista Siano, vice president of business transformation at PSG; and Patty Starr, president and CEO of the Health Action Council.

Vivid Clear Rx is one of several mid-size PBMs, a group that includes Navitus Health Solutions and MedImpact, that are challenging the grip that the big three have on the PBM industry. Wadstrom said her approach at Vivid Clear Rx is to combine trust-building with what she called common sense — something she said can be surprisingly hard to find in the pharmacy benefit industry. Her advice for spotting a bad deal was blunt. “If it doesn't sound right, it probably isn't. If you have to have three asterisks to explain what you're saying, there's a problem there,” she said.

The long-term viability of the mid-size and smaller PBMs is an issue that employers consider and may give them pause, said Wadstrom, and she acknowledged that there is legitimate concern about how long PBMs owned by private equity firms will stay in business. She noted the contrast to Vivid Clear Rx, which is owned by Hy-Vee, a grocery store headquartered in the Midwest that started as a general store in a small town in Iowa in 1930. She said that parent company's roots in customer service and ethics, rather than a shorter-term financial timeline, are part of what Vivid Clear Rx tries to bring to the pharmacy benefit industry.