EHIM, Inc.

What EHIM, Inc. does

EHIM, Inc. (legal name Employee Health Insurance Management, Inc.) is a private Pharmacy Benefit Manager (PBM) and Third Party Administrator (TPA) headquartered in Southfield, Michigan, founded in 1987 and operating as an affiliated entity under ProCare Rx. The company delivers pharmacy benefit management services to self-insured employers, insurance carriers, TPAs, and employers in the workers' compensation and auto insurance industries, with a reported footprint of over 64,000 in-network pharmacies and approximately 3 million lives served nationwide.

EHIM's core offering centers on cloud-based claims processing with web portal access for administrators, members, and providers, supporting electronic data transfers from primary carriers, real-time eligibility updates, and coordinated provider payments. Differentiated capabilities include custom injury-specific formularies (not rebate-driven), medication therapy management for workers' comp claimants, first fill and limited fill programs for auto-PIP claims, and a 91.3% lower specialty pharmacy trend versus industry benchmarks (0.73% EHIM vs. 8.4% industry, 2022 data). Product surface extends to Special Medical Reimbursement Programs, FSA/COBRA/HRA administration, dental plan administration via Dentemax, a benefits debit card, mail order pharmacy through Walgreens/OPTUMRx/Immediate Pharmaceutical Services, concierge member services, and 360-degree PBM auditing and consulting.

The business model combines subscription/recurring administrative and per-script fees across PBM and TPA revenue streams, sold through a dedicated enterprise field sales motion targeting self-insured employers and carriers with customized quote-based pricing (standard $2.50 PEPM agent commission disclosed). EHIM emphasizes in-house 24/7/365 customer service, educational outreach, and detailed accountability reporting as its service philosophy, branded 'The EHIM Experience.' The company is HIPAA compliant, private, and operates as a subsidiary/affiliate of ProCare Rx with no disclosed external institutional ownership or funding rounds.

Name

EHIM, Inc.

Legal name

Employee Health Insurance Management, Inc.

Website

https://ehimrx.com

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

51–100 employees

Short description

EHIM is a private Pharmacy Benefit Manager and Third Party Administrator serving self-insured employers, insurance carriers, and TPAs across commercial, workers' compensation, and auto-PIP lines, delivering cloud-based claims processing, custom injury-specific formularies, and integrated administration services to roughly 3 million lives nationwide.

Ownership category

akta.pro rank

Product category

Pharmacy Benefit Management (PBM) and Benefits Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Insurance Agents, Brokers & Service (6411), Services-Health Services (8000)

akta.pro primary industry

Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI)

Keywords

• Pharmacy benefit management
• Third party administration
• Workers compensation pharmacy
• Flexible spending administration
• Health reimbursement accounts

Headquarters

HQ city

Southfield

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. PBM Services: Pharmacy Benefit Management services including custom formularies, cost containment strategies, utilization management, and specialty pharmacy services. Revenue generated through administrative fees and/or prescription processing fees.
2. TPA Administration Services: Third Party Administration services for Special Medical Reimbursement Programs including FSA/COBRA administration, debit card programs, vision and hearing services, and dental plan administration. Revenue generated through administration fees.
3. Workers' Compensation PBM: Pharmacy benefit management services for workers' compensation industry including customized injury-based formularies, clinical programs, and cost management strategies for short and long term claimants.
4. Auto/PIP PBM Services: Comprehensive PBM services to auto insurance industry including injury-based formularies, first fill programs, limited fills programs, and long-term auto claims management.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels5 records

Core offering

EHIM is a Pharmacy Benefit Manager (PBM) and Third Party Administrator (TPA) that designs and administers prescription drug benefit programs for self-insured employers, insurance carriers, TPAs, workers' compensation programs, and auto insurance carriers. The company also administers ancillary consumer-directed benefits such as FSAs, HRAs, COBRA, and dental plans, and offers PBM auditing, consulting, and concierge member services supported by web portals and a national pharmacy network.

Product overview

EHIM is a Pharmacy Benefit Manager (PBM) and Third Party Administrator (TPA) offering a comprehensive suite of pharmacy and healthcare administration services. The core offerings include Pharmacy Benefit Management with a network of over 64,000 pharmacies serving nearly 3 million lives, Special Medical Reimbursement Programs (SMRPs) through their TPA division, and Workers' Compensation/Auto-PIP pharmacy services. These core services are supported by web-based portals for administrators, members, and providers, along with add-on modules including FSA and HRA management, COBRA administration, dental plan administration, mail order pharmacy programs through partners like OPTUMRx and Walgreens, a benefits debit card program, concierge services, and PBM auditing and consulting. The company's service philosophy, branded as 'The EHIM Experience,' emphasizes accountability, customization, 24/7 in-house customer service, and cloud-based data reporting.

Differentiator

Problem solved

Functional benefit

Products and services

• Pharmacy Benefit Management (PBM)

Quantifiable outcome

• 91.3% lower specialty pharmacy costs compared to industry benchmark (0.73% EHIM vs 8.4% industry in 2022)
• +3 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature4 records

Partnerships

Five partnerships are on record, tiered supporting and core.

• DentemaxsupportingTechnology or IntegrationEHIM offers self-funded dental plans utilizing the Dentemax dental PPO network. Members can search for Dentemax participating dentists at www.dentemax.com/members or call (800) 752-1547.
• WalgreenscoreChannel Partner/ Reseller/ DistributorWalgreens serves as a mail order pharmacy provider for EHIM cardholders. EHIM works with Walgreens to track mail order usage and maximize benefits. Members can download forms for Walgreens Mail Order or enroll online at www.rx.procarerx.com.
• OPTUMRx (Prescription Solutions)coreChannel Partner/ Reseller/ DistributorOPTUMRx (formerly Prescription Solutions) provides mail order pharmacy services for EHIM groups. Can deliver 90-day supplies of medications right to members' mailboxes, often for less than retail pharmacy. Members can order by phone at 1-888-877-9907 or online at www.optumrx.com.
• Immediate Pharmaceutical ServicessupportingChannel Partner/ Reseller/ DistributorEHIM cardholders can order prescriptions through Immediate Pharmaceutical Services as part of the mail order pharmacy program.
• ProCare RxcoreTechnology or IntegrationEHIM is powered by ProCare Rx, which provides enabling technology for pharmacy benefit management. The relationship involves shared technology infrastructure, customer service ([email protected]), and corporate operations. EHIM directs users to ProCare Rx for commercial PBM services and the new website at procarerx.com.

Scale indicators5 records

Recent moves4 records

Expansion highlights5 records

Direct peers

• ProCare Rx: EHIM's parent and technology provider, ProCare Rx is a PBM that offers commercial pharmacy benefit management powered by the same platform EHIM uses. The two are operationally intertwined and target overlapping client segments including self-insured employers and TPAs.
• Navitus Health Solutions: A mid-sized, transparent, pass-through PBM serving employer-sponsored and health plan clients with custom formulary design. Navitus is one of the closest comparables to EHIM in scale, model philosophy, and target buyer segments.
• MedImpact Healthcare Systems: An independent, mid-to-large PBM offering commercial, managed care, and specialty pharmacy programs. MedImpact competes with EHIM for self-insured employer and health plan relationships with a similar transparent, customizable approach.
• Elixir Solutions: A PBM and pharmacy services provider serving health plans, employers, and government programs with focus on specialty management and clinical programs. Comparable to EHIM in size and in the breadth of PBM plus adjacent benefit services.
• RxBenefits: A PBM partner focused on brokers and TPAs serving mid-market and small employer groups. RxBenefits targets a similar channel and buyer profile as EHIM's TPA and self-insured employer motion.

Emerging players

• SmithRx: A technology-forward PBM focused on transparent, pass-through pricing for self-insured employers. SmithRx represents the newer wave of niche PBMs competing with EHIM on transparency and employer self-service experience.
• Capital Rx: A technology-focused PBM operating on a unified claims processing platform with a transparent pricing model. Capital Rx is an emerging competitor emphasizing modern technology and aligned economics versus traditional PBMs like EHIM.

Broad incumbents

• Prime Therapeutics: A large, Blue Cross Blue Shield-aligned PBM serving health plan clients with commercial and government programs. Prime is a broader competitor to EHIM in commercial and specialty PBM, though oriented toward payer-owned clients.
• OptumRx (UnitedHealth Group): The largest PBM in the U.S. and EHIM's mail order partner, also a direct competitor in commercial PBM. OptumRx's scale, integrated Optum services, and rebate leverage represent the upper bound of competitive intensity for any mid-sized PBM.
• CVS Caremark: One of the three largest PBMs in the U.S. and a benchmark competitor for commercial PBM, specialty, and mail order services. CVS Caremark's scale, retail integration, and rebate economics set the competitive floor for EHIM's commercial book of business.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xtwitter.com/ehimrx
• Facebookfacebook.com/EHIMRx
• LinkedInlinkedin.com/company/ehim-inc-

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 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 EHIM, Inc.