Upstart PBMs aim to shake up the market

November 13, 2023

Pharmacy benefit managers operating in the shadows of conglomerates that dominate the industry believe now may be their moment to make inroads in the lucrative market.
Companies such as AffirmedRx, Liviniti, MedOne Pharmacy Benefit Solutions Rx, Navitus Health Solutions, RxPreferred Benefits and SmithRx are employing a twofold strategy. Part one is pitching potential customers on a more transparent business model. Part two is lobbying Congress to pass legislation that would rein in CVS Health subsidiary CVS Caremark, UnitedHealth Group subsidiary OptumRx and Cigna subsidiary Express Scripts and open the PBM business to more competition.

Stay Informed and Connected

Receive expert insights, healthcare tips, and important updates on pharmacy benefits, drug recalls, and more—straight to your inbox.

Navigating with a trusted partner

Now Available: 9th Annual Drug Trend Report

Our Drug Trend Report provides a clear view of the trends shaping pharmacy benefits today, along with strategies that are delivering real savings without compromising care.

Related blogs

Navigating Healthcare and Improving Outcomes

Spotlight: Carrie Aiken, Chief Administrative Officer

Spotlight: Carrie Aiken, Chief Administrative Officer

We recently sat down with Carrie Aiken, Chief Administrative Officer, to discuss her strategic areas of focus — including Human Resources (HR) and Compliance — at Navitus. Tell us more about your position as Chief Administrative Officer, and what you…

2024 Drug Trend Report – Five Key Takeaways

2024 Drug Trend Report – Five Key Takeaways

Our 2024 Drug Trend Report reveals how plan sponsors have navigated inflationary pressures, utilization increases and breakthrough therapies, while still controlling costs through transparency and proactive management. All of which are needed more than…

Trend Over Time: Saving Money Isn’t a Race, It’s a Marathon

Trend Over Time: Saving Money Isn’t a Race, It’s a Marathon

Partnering with the right pharmacy benefit manager (PBM) is about more than year-one savings. It’s about finding a PBM that truly understands and aligns with a payer’s needs, now and in the future.  10+ Years of Savings  One of our clients, Self-Insured…

Rx Disruptors: Navitus Transparent Takedown

Rx Disruptors: Navitus Transparent Takedown

The Industry Problem and the Navitus Solution  Traditional pharmacy benefit managers (PBMs), who currently control 80% of the pharmacy benefit management marketplace, have received intense media and regulatory scrutiny for their business practices….

Navitus Expands Digital Health Offerings with Hello Heart

Navitus Expands Digital Health Offerings with Hello Heart

At Navitus, we believe smarter pharmacy benefit management isn’t just about lowering drug costs. It’s about improving lives. Our approach goes beyond medication management to address the broader physical and financial well-being of the members we serve.  …

The Role of Rebates in Pharmacy Benefits

The Role of Rebates in Pharmacy Benefits

In this blog, we’ll break down how rebates work, why they’ve come under increased scrutiny and how transparency — especially from your pharmacy benefit manager (PBM) — can help your organization truly lower prescription drug costs. …

PBM 101: Understanding Spread Pricing and Its Impact on Plan Costs 

PBM 101: Understanding Spread Pricing and Its Impact on Plan Costs 

There is no shortage of questions surrounding pharmacy benefit business models, especially when medication costs continue to rise. One major area of concern centers on a practice that often goes unnoticed or not understood: spread pricing.  …

Part D Star Ratings Adherence Measures: Enabling Strategic and Focused Support for High-risk Beneficiaries Through the Reporting and Intervention for Stars Excellence (RISE) Program

Part D Star Ratings Adherence Measures: Enabling Strategic and Focused Support for High-risk Beneficiaries Through the Reporting and Intervention for Stars Excellence (RISE) Program

Authors: Wenxuan Cai, PharmD, PhD; Amanda Lee, PharmD; Caitlin Albrecht, PharmD; Maria Basak, CPhT; Casey Herlache; Capriana Hadel, MBA Executive Summary Adherence to key medication classes is a critical metric for evaluating health plan quality and continuous…

PBM 101: How to Evaluate Your PBM

PBM 101: How to Evaluate Your PBM

Choosing a pharmacy benefit manager (PBM) isn’t just about managing prescription drug costs – it’s about ensuring your PBM operates in a way that aligns with your financial, operational and philosophical goals. A truly aligned PBM works toward the same…

previous arrow
next arrow