CerpassRx

What CerpassRx does

CerpassRx is a U.S.-based pharmacy benefit manager (PBM) headquartered in The Colony, Texas, operating as Healthcare Highways Rx, LLC. Founded in 2015 and employing 101-250 people, the company delivers pharmacy benefits administration, clinical programs, and cost-containment services to self-insured employers, health plans, and plan members. Its core product is a PBM platform supported by 15+ clinical and specialty solutions, with add-on modules including a pharmacy discount card, prior authorization services, and the Intelligent Specialty Engine.

The Intelligent Specialty Engine, launched in November 2024 in partnership with Waltz Health, applies AI-powered real-time analytics to specialty drug pricing, pharmacy network costs, and spending data, routing prescriptions to cost-effective pharmacies. Specialty drug spend accounts for over 50% of total drug spend, making this the company's primary technology differentiator. The platform processes structured data and provides decision support to health plans and self-insured employers managing complex specialty therapies.

CerpassRx generates revenue through a combination of recurring administrative fees for PBM services (quote-based, annual contracts negotiated individually by plan size and benefit requirements) and transaction fees from its consumer-facing pharmacy discount card program. The go-to-market is sales-led and partnership-driven, with hands-on implementation and customized benefit design for each client. The company also operates a member services model that places 2 outbound calls for every 5 incoming calls. In July 2025, LucyRx signed a definitive agreement to acquire CerpassRx from Nomi Health, and the deal closed in October 2025, positioning CerpassRx as part of LucyRx's national PBM platform.

Name

CerpassRx

Legal name

Healthcare Highways Rx, LLC

Website

https://cerpassrx.com

Company type

Private

Founded year

2015

Operating status

Acquired

Headcount range

11–50 employees

Short description

CerpassRx is a U.S. pharmacy benefits manager serving self-insured employers and health plans with PBM administration, clinical programs, and the AI-powered Intelligent Specialty Engine for specialty drug cost management. The company was acquired by LucyRx in October 2025.

Ownership category

akta.pro rank

Product category

Pharmacy Benefits Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE)

akta.pro secondary industries

Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Prior Authorization, Utilization Management & Step Therapy (HLAEAKAG), Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN)

Keywords

• Pharmacy benefits management
• PBM services
• Specialty drug management
• Prior authorization
• Prescription discount cards

Headquarters

HQ city

The Colony

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

Revenue model

1. Pharmacy Benefits Management Services: Core PBM services providing pharmacy benefit administration to self-insured employers and health plans. Revenue generated through a combination of administrative fees and transaction-based pricing for prescription processing.
2. Pharmacy Discount Card Program: Consumer-facing prescription discount card program allowing individuals without insurance to access discounted medications at participating pharmacies. Revenue derived from transaction fees negotiated with pharmacies.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

CerpassRx is an independent pharmacy benefits manager (PBM) that administers prescription drug benefits for self-insured employers and health plans. Its offerings include core PBM administration, a consumer pharmacy discount card, prior authorization services, and the AI-powered Intelligent Specialty Engine for specialty drug spend management. The company focuses on high-touch member services, customized clinical programs, and transparent pricing as an alternative to traditional PBM models.

Product overview

CerpassRx operates as a next-generation pharmacy benefits manager (PBM) offering a unified PBM platform with multiple integrated services. The core product is Pharmacy Benefits Management, supplemented by the CerpassRx Pharmacy Discount Card for out-of-pocket prescription savings, Prior Authorization Services for streamlined medication approvals, and the Intelligent Specialty Engine (in partnership with Waltz Health) for AI-powered specialty drug spend optimization. The company positions itself as an alternative to traditional PBM models, emphasizing clinical excellence, cost containment, and high-touch member service with over 15 clinical and specialty solutions.

Differentiator

Problem solved

Functional benefit

Products and services

• Pharmacy Benefits Management (PBM) Core PBM service offering pharmacy benefit administration, clinical programs, and cost-containment strategies focused on member experience and plan savings for self-insured employers and health plans.
• CerpassRx Pharmacy Discount Card A prescription discount card program that provides discounts on medications at participating pharmacies, available as both physical and digital cards for uninsured or underinsured individuals.
• Prior Authorization Services Prior authorization management services integrated into the PBM platform to streamline approval workflows for medications requiring authorization.
• Intelligent Specialty Engine AI-powered platform developed in partnership with Waltz Health that manages specialty drug spend through real-time analytics and competitive pharmacy network routing to cost-effective pharmacies.

Quantifiable outcome

• 94% of employees report CerpassRx is a Great Place to Work
• +2 more outcomes

Segments4 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature2 records

Partnerships

Two partnerships are on record, tiered core.

• LucyRxcoreStrategic or Co-development Partner · 31 July 2025LucyRx, a next-generation PBM, acquired CerpassRx (a division of Nomi Health) in Q3 2025. The acquisition combined LucyRx's technology-driven clinical model and formulary marketplace with CerpassRx's cost containment expertise and high-touch service approach to form a more comprehensive national PBM platform.
• Waltz HealthcoreTechnology or Integration · 11 November 2024CerpassRx partnered with Waltz Health to launch the Intelligent Specialty Engine, an AI-powered platform for specialty drug spend management. The platform utilizes real-time analytics and a competitive pharmacy network to route specialty prescriptions to cost-effective pharmacies, providing data analytics for health plans and self-insured employers facing specialty drug cost pressures.

Scale indicators5 records

Recent moves4 records

Expansion highlights4 records

Broad incumbents

• Express Scripts: PBM owned by The Cigna Group, one of the three largest PBMs in the U.S. Provides overlapping PBM, specialty pharmacy, and utilization management services to large employer and health plan customers; primary traditional-PBM incumbent.
• CVS Caremark: PBM arm of CVS Health, one of the "Big Three" PBMs. Overlaps with CerpassRx on pharmacy benefit administration, specialty drug management, and retail pharmacy network; serves as the dominant traditional-PBM competitor CerpassRx explicitly positions against.
• OptumRx: Largest U.S. PBM by prescription volume, part of UnitedHealth Group. Broad incumbent in the same industry with overlapping pharmacy benefit administration, specialty pharmacy, and clinical programs, but operates at vastly greater scale with vertically integrated payer/provider assets.

Direct peers

• SmithRx: Transparent PBM targeting self-insured employers with a technology-first platform. Directly comparable to CerpassRx in customer segment (self-insured employers), value proposition (transparency/lower-cost alternative to traditional PBMs), and product surface area.
• Capital Rx: Technology-driven PBM offering Judi, a unified pharmacy benefit claims processing platform, to employers and health plans. Comparable to CerpassRx in positioning as a tech-forward, transparent alternative to the "Big Three" PBMs and in targeting self-funded plans.
• Navitus Health Solutions: Independent, fully transparent PBM serving health plans, employers, and government programs. Direct peer in transparent-PBM positioning and core PBM service offering, with comparable clinical and specialty management capabilities.
• RxBenefits: PBM focused exclusively on self-insured employers, particularly mid-market employers via broker relationships. Highly comparable customer segment and PBM-services scope to CerpassRx, with emphasis on clinical programs and cost containment.
• LucyRx: Next-generation PBM that acquired CerpassRx in October 2025. Operates a technology-driven clinical model with a formulary marketplace — the closest direct peer given CerpassRx is now a division of LucyRx and shares its national PBM platform strategy.
• EmpiRx Health: Smaller transparent PBM targeting self-funded employer plans with a clinically focused, member-centric model. Comparable in scale, customer segment, and "alternative to traditional PBM" value proposition to CerpassRx.

Emerging players

• Waltz Health: AI-powered specialty drug search and routing platform — CerpassRx's technology partner that built the Intelligent Specialty Engine. Comparable as an emerging AI-driven player focused on specialty drug cost optimization; potentially enabling to other PBMs as well.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/CerpassR

Revenue estimate

Valuation estimate

Number of profiles

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 CerpassRx