PBIRx

What PBIRx does

PBIRx Inc. is a privately held, founder-owned pharmacy benefit consulting firm headquartered in Shelton, Connecticut, founded in 1993 by Patricia A. Sirowich, a former Express Scripts co-founder. The firm provides PBM-agnostic advisory services to self-funded employer groups, Taft-Hartley and labor union welfare funds, hospitals and health systems, third-party administrators, and brokers/consultants. Its core service lines are pharmacy benefit consulting, rebate aggregation, and the proprietary AuditRx claims auditing platform, supplemented by add-on offerings including the PB Fusion Integrated Discount Card, international prescription services, specialty drug alternate funding, and 340B compliance audits.

The company's underlying technology centers on AuditRx, a proprietary prescription benefit audit program operational since 2001 that performs claims auditing, reporting, and reconciliation to identify PBM discrepancies and deliver financial recoveries. This is paired with CTIRx (Clinical Technology Intelligence), which monitors monthly client claims data using clinical management rules and proprietary algorithms to flag outliers, formulary opportunities, and manufacturer-level market share shifts. Both are registered trademarks and the firm holds SOC2 Type II certification, supporting enterprise and hospital procurement requirements.

PBIRx generates revenue through professional services fees tied to engagement scope, with go-to-market executed via direct enterprise field sales, dedicated account consultants, and free upfront evaluations. The firm claims cumulative client savings of over $500 million across hundreds of clients since inception, anchored by long-tenured relationships such as a 20+ year engagement with Quinnipiac University. Leadership is founder-led and family-involved, with no disclosed institutional capital, M&A activity, or product pivots; growth is funded organically through consulting fees.

Name

PBIRx

Legal name

PBIRx Inc.

Website

https://pbirx.com

Company type

Private

Founded year

1993

Operating status

Operating

Headcount range

11–50 employees

Short description

PBIRx is a privately held, founder-owned pharmacy benefit consulting firm that provides PBM-agnostic auditing, contract negotiation, rebate aggregation, and clinical analytics to self-funded employers, Taft-Hartley funds, hospitals, TPAs, and brokers via its proprietary AuditRx platform.

Ownership category

akta.pro rank

Product category

Pharmacy Benefit Consulting

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)

SIC

Insurance Agents, Brokers & Service (6411), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)

akta.pro secondary industries

Claims Processing, Adjudication & Payment Integrity (HLAEAKAC), 340B Program Administration & Support (HLAEAKAJ), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN), Manufacturer Contracting, Rebates & Revenue Management (HLAEAKAD)

Keywords

• Pharmacy benefit consulting
• PBM auditing services
• Rebate aggregation
• 340B compliance audits
• Specialty drug management

Headquarters

HQ city

Milford

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Pharmacy Benefit Consulting Services: Professional consulting services for managing pharmacy benefits including contract negotiation, auditing, rebate aggregation, and clinical program management. Services provided to self-funded clients with fees likely based on engagement scope and complexity.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels5 records

Core offering

PBIRx is a pharmacy benefit consulting firm that provides independent, PBM-agnostic advisory services to self-funded employer groups, Taft-Hartley plans, hospitals, TPAs, and brokers. Core deliverables include PBM contract negotiation, prescription benefit auditing (via proprietary AuditRx platform), rebate aggregation, clinical program management, specialty drug alternate funding, international prescription sourcing, and 340B compliance audits. Revenue is generated through professional service engagements supported by proprietary data analytics and clinical intelligence technology.

Product overview

PBIRx is a pharmacy benefit consulting firm offering a comprehensive suite of services built around its proprietary technology platform. The core offering consists of Pharmacy Benefit Consulting, AuditRx (proprietary auditing platform), and Rebate Aggregation Services. These are complemented by specialized add-on modules including PB Fusion Integrated Discount Card, International Prescription Services, Specialty Drug Alternate Funding, and 340B Compliance Audits. The company also offers a proprietary Clinical Technology Intelligence (CTIRx) system that provides clinical management and outlier identification. The portfolio is unified by PBIRx's proprietary data analytics and auditing technology that enables the company to identify savings opportunities, audit PBM contracts, and optimize pharmacy benefit outcomes for self-funded employer groups, hospitals, Taft-Hartley organizations, and TPAs.

Differentiator

Problem solved

Functional benefit

Brands

• AuditRx: PBIRx's proprietary prescription benefit audit program that uncovers discrepancies and delivers financial recoveries to clients through claims auditing, reporting and reconciliation.
• Clinical Technology Intelligence (CTIRx)
• PB Fusion Integrated Discount Card
• Pharmacy Benefit Actuarial Services (PBAS)

Products and services

• Pharmacy Benefit Consulting Core individualized consulting and auditing services for self-funded employer groups, Taft-Hartley plans, hospitals, TPAs, and brokers, including PBM contract management, claims data analysis, customized monthly reporting, and clinical programs.
• AuditRx Pharmacy Benefit Auditing PBIRx's proprietary prescription benefit audit program providing claims auditing, reporting and reconciliation to hold PBMs accountable, uncover hidden discrepancies, and recover funds for clients.
• Rebate Aggregation Services Formulary management and rebate administration services that maximize savings through negotiation with pharmaceutical manufacturers, rebate intermediary processing, and distribution to clients.
• PB Fusion Integrated Discount Card Fully integrated PBM and discount networks claim adjudication solution for plan sponsors and members.
• International Prescription Services International home delivery program through strategic partnerships providing voluntary brand-only medications from outside the USA, dispensed by licensed pharmacists in original manufacturer sealed packaging, with integrated claims data reporting to maximize plan savings.
• Specialty Drug Alternate Funding Best-in-class solutions for specialty drug alternate funding to manage high-cost specialty medications for self-funded plan sponsors.
• 340B Compliance Audits Independent third party 340B compliance audits providing actionable evaluation reports to prepare covered entities for HRSA audits, including on-site audit teams staffed with pharmacists and analysts.

Quantifiable outcome

• $500,760,216 in total client savings
• +3 more outcomes

Named customers3 records

Segments5 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability2 records

Feature2 records

Partnerships

Two partnerships are on record, tiered core and key account.

• International Pharmacy PartnerscoreStrategic or Co-development PartnerPBIRx offers clients a unique international home delivery program through strategic partnerships with international pharmacies. These partnerships allow for dispensing of prescription drugs by licensed pharmacists in original manufacturer sealed packaging, delivered directly to members. The arrangement integrates claims data for reporting while maximizing plan savings.
• Quinnipiac Universitykey accountOthersLongstanding partnership spanning over 20 years with Quinnipiac University for pharmacy benefits management services, providing substantial cost savings through higher rebates, lower rates, and international prescription program.

Scale indicators5 records

Recent moves7 records

Expansion highlights4 records

Direct peers

• Pharmaceutical Strategies Group (PSG): PSG is a pharmacy benefit consulting and PBM advisory firm offering PBM contract management, clinical programs, and analytics to plan sponsors — closely overlapping with PBIRx's core consulting, rebate aggregation, and audit offerings across employer, health plan, and government clients.
• Artemetrx: Artemetrx provides PBM claims analytics and audit services for self-funded employers and health plans, competing most directly with PBIRx's AuditRx auditing platform and contract oversight capabilities.
• RxBenefits: RxBenefits is a pharmacy benefit consulting and administration firm partnering with brokers and TPAs — operating in the same PBM-oversight and pharmacy cost-management niche that PBIRx addresses through its consulting and broker channel.
• EmpiRx Health: EmpiRx Health is a PBM that emphasizes transparent, clinical-first models for self-funded employers — overlapping with PBIRx's specialty drug clinical management, formulary oversight, and employer consulting capabilities.
• Visante: Visante is a pharmacy management consulting firm serving health systems and plan sponsors on 340B, specialty pharmacy, and PBM strategy, mirroring PBIRx's hospital/health-system and 340B audit offerings.

Broad incumbents

• Lockton: Lockton is one of the largest independent insurance brokers with a benefits consulting practice that includes pharmacy benefit advisory work to large employers — competing in the same broker/consultant client segment PBIRx serves.
• Mercer (Oliver Wyman): Mercer (part of Oliver Wyman / Marsh McLennan) is a major benefits consultancy offering PBM procurement, vendor management, and pharmacy strategy services to large employers, overlapping with PBIRx at the consulting and broker end of the market.
• WTW (Willis Towers Watson): WTW is a global advisory, broking, and solutions firm with a benefits practice that includes pharmacy benefit consulting and PBM selection support for large employer clients — a broad incumbent competing for the same enterprise RFPs.
• Segal Group: Segal is a benefits and HR consulting firm with strong Taft-Hartley and public-sector practice, providing pharmacy benefit consulting that directly overlaps with PBIRx's Taft-Hartley and welfare fund engagement.
• Milliman: Milliman is a global actuarial and consulting firm with a dedicated pharmacy benefit practice covering PBM audit, specialty drug, and 340B analytics — an incumbent alternative for the same employer and health plan buyers PBIRx addresses.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/pbirx

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about PBIRx