MedImpact Healthcare Systems

Name

MedImpact Healthcare Systems

Legal name

MedImpact Healthcare Systems, Inc.

Website

https://medimpact.com

Company type

Private

Founded year

1990

Operating status

Operating

Headcount range

5,001–10,000 employees

Ownership category

akta.pro rank

Product category

Pharmacy Benefit Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Pharmacies and Drug Retailers (456110)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Formulary Management & Clinical Pharmacy Programs (HLAEAKAA)

akta.pro secondary industries

Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK), Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE)

Keywords

• Pharmacy benefit management
• Formulary management services
• Specialty pharmacy solutions
• Medication adherence programs
• Clinical health management

Headquarters

HQ city

San Diego

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Pharmacy Benefit Management Services: Core PBM services including formulary management, pharmacy network administration, rebate negotiation, and utilization management for health plan clients, employers, unions, and government programs.
2. Clinical Programs: Value-added clinical programs including GLP-1 management, medication adherence programs, and disease management offered as part of PBM contracts.
3. Biosimilar Distribution: Offering biosimilar medications (e.g., Humira biosimilar at 95% below brand cost) to hospitals and pharmacies through the PBM network.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels5 records

Core offering

MedImpact Healthcare Systems operates as an independent pharmacy benefit manager (PBM), providing formulary management, pharmacy network administration, rebate negotiation, and utilization management for health plans, employers, unions, and government programs. The company delivers these services through the integrated Med360i platform and modular offerings including specialty pharmacy management, home delivery, government compliance solutions, and AI-driven clinical and wellness programs such as MedEmpower Fuel and GLP-1 Benefit 360.

Product overview

MedImpact Healthcare Systems operates as a modular pharmacy benefit management (PBM) platform with multiple integrated solutions. The core MedImpact platform provides advanced pharmacy benefits management, supplemented by specialized modules including MedSolutions (clinical programs), MedSpecialty (specialty medications), MedMail (home delivery), MedGov (government programs), and MedEmpower (consumer wellness including MedEmpower Fuel with AI-powered nutrition tracking). The Med360i platform unifies these offerings with integrated analytics. Following acquisitions of Sav-Rx (organized labor expertise) and Elixir Solutions, MedImpact now encompasses additional specialized PBM capabilities while maintaining distinct brand identities.

Differentiator

Problem solved

Functional benefit

Products and services

• Med360i

Quantifiable outcome

• 84% of enrolled members achieved weight goals after 12 months in GLP-1 Benefit 360 program
• +2 more outcomes

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability4 records

Feature4 records

Partnerships

One partnership is on record.

• Vertigard (Health In Tech)minorGTM or Marketing Partner · 1 August 2025MedImpact's Vertigard product is a distribution partner integrated with Health In Tech's enhanced eDI platform, expanding distribution network to 778 partners through third-party administrators and brokers. Health In Tech Q2 2025 earnings mentioned this partnership as part of their expanded distribution network.

Scale indicators5 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Express Scripts (Evernorth/Cigna): One of the largest PBMs in the US, serving health plans, employers, and government programs with formulary management, mail-order pharmacy, and specialty drug services. Directly competes with MedImpact in employer and health plan RFPs, with the key distinction of being owned by a major payer (Cigna).
• CVS Caremark (CVS Health): The PBM arm of CVS Health, serving employers, health plans, and government clients with pharmacy benefit management and integrated retail pharmacy network. Direct competitor to MedImpact with structural advantages from being part of a vertically integrated pharmacy retailer.
• OptumRx (UnitedHealth Group): The PBM division of UnitedHealth Group, managing pharmacy benefits for commercial, Medicare, and Medicaid populations. Direct competitor in employer and health plan segments, with payer-ownership differentiation similar to CVS Caremark and Express Scripts.
• Prime Therapeutics: A PBM owned by a consortium of Blue Cross Blue Shield plans, serving health plan clients with pharmacy benefit management and specialty pharmacy services. Most direct comparable to MedImpact as a non-investor-owned PBM serving payer clients, though anchored to a specific BCBS ecosystem.
• Humana Pharmacy Solutions: The PBM arm of Humana, with particular strength in Medicare Part D and senior-focused benefit administration. Comparable to MedImpact's Medicare Part D and senior-focused offerings (e.g., MedEmpower Fuel), though narrower in commercial employer segments.

Emerging players

• Capital Rx: A technology-forward PBM offering a claims-processing platform (Judi) with transparent pricing and modular service design. Emerges as a challenger PBM in the same 'independent, transparent, technology-led' positioning MedImpact cultivates, with overlap in self-insured employer and union segments.
• SmithRx: A venture-backed independent PBM focused on self-insured employers with transparent pass-through pricing. Competes with MedImpact in the SMB and mid-market employer PBM segment with a similar independent positioning.
• RxBenefits: A PBM partner for benefits brokers serving small and mid-sized employers, providing pharmacy benefit contracting and clinical management. Competes with MedImpact in the broker-served employer segment with a focus on scaled-down, mid-market accounts.

Broad incumbents

• Cigna Group (Evernorth Health Services): Parent of Express Scripts and Evernorth, one of the largest integrated health services platforms globally. Comparable as the broader incumbent whose PBM is the largest direct competitor to MedImpact, and represents the consolidated payer-owned model MedImpact is differentiated against.
• UnitedHealth Group (Optum): Parent of OptumRx and Optum Health, the largest healthcare company by revenue globally. Comparable as the broad incumbent payer-PBM that anchors the integrated competitor set MedImpact competes against for large employer and government accounts.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/MedImpact
• LinkedInlinkedin.com/company/medimpact
• Facebookfacebook.com/medimpacthcs

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Subsidiaries4 records

Funding overview

Funding rounds1 record

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about MedImpact Healthcare Systems