Medone Healthcare

What Medone Healthcare does

MedOne Healthcare, doing business as MedOne Pharmacy Benefit Solutions, is a private, family-owned pharmacy benefit manager (PBM) founded in 1999 in Dubuque, Iowa. The company administers prescription drug benefits for self-funded employers, organizations, government entities, trade unions, and channel partners (brokers, consultants, and pharmacy benefit administrators) across all 50 states. Its core PBM offering operates on a transparent, pass-through pricing model — admin fees are structured as Per Member Per Month (PMPM, averaging ~$60) rather than spread pricing or revenue tied to drug spend, with 100% of rebates and discounts passed through to plan sponsors and performance guarantees backed by at-risk commitments.

The technology stack centers on a proprietary Clinical Care Path Suite of 18 clinical programs (including Opioid Care Path and Behavioral Care Path), an in-house mail order and specialty pharmacy (MedOne Pharmacy Services with MedSync synchronization), the RxAlly specialty cost containment sub-brand, and the myMedOne member portal — built in-house by the company's IT team — supporting prior authorization tracking, prescription history, drug pricing lookup, and direct member reimbursement. Integration partners include CoverMyMeds (electronic prior authorization), RelayHealth (claims routing redundancy following the Change Healthcare cyberattack), Mark Cuban Cost Plus Drug Company (biosimilar access, e.g., YUSIMRY at 90%+ below HUMIRA list), Nanodropper (MediSplit program), Brightn (behavioral health), and Tria Health (GLP-1 wellness support). MedOne is SOC 2 Type 2 certified and reports net PMPM spend 43.5% below industry average, with 90%+ biosimilar conversion rates and 673% membership growth since 2018.

The business model combines subscription recurring PMPM admin fees, outcome-based performance guarantees, and managed services revenue from formulary management, specialty drug management, biosimilar adoption, and utilization management. Distribution is hybrid — direct enterprise sales by account management teams plus a channel partner ecosystem with broker/consultant resellers supported by ROI calculators. In April 2026, MedOne extended vertically into direct care delivery by opening its first primary care clinic (MedOne Healthcare Partners) in Worthington, Ohio. The company remains privately held with no disclosed institutional funding rounds.

Name

Medone Healthcare

Legal name

MedOne Pharmacy Benefit Solutions

Website

https://medone-rx.com

Company type

Private

Founded year

1999

Operating status

Operating

Headcount range

11–50 employees

Short description

MedOne is a private, family-owned transparent pharmacy benefit manager (PBM) founded in 1999, serving self-funded employers and channel partners across all 50 states via a pass-through pricing model, an 18-program Clinical Care Path Suite, and an in-house member portal and mail order pharmacy.

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), Insurance and Employee Benefit Funds (5251), Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

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

akta.pro secondary industries

Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Claims Processing, Adjudication & Payment Integrity (HLAEAKAC), Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Prior Authorization, Utilization Management & Step Therapy (HLAEAKAG), Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN)

Keywords

• Pharmacy benefit management
• Transparent pass-through PBM
• Specialty drug cost containment
• Clinical care pathways
• Self-funded employer benefits

Headquarters

HQ city

Dubuque

HQ country

United States

HQ region

North America

Offices3 records

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. PMPM Administrative Fees: MedOne charges transparent, aligned Per Member Per Month (PMPM) administrative fees. Revenue is not driven by increasing prescription spend, aligning MedOne's incentives with plan sponsors.
2. Performance-Based Pricing: MedOne operates on a pass-through model with guaranteed results. They go at-risk to ensure all financial guarantees are met for plan sponsor clients.
3. Cost Containment Services: Revenue derived from clinical and cost containment strategies including formulary management, specialty drug management, biosimilar adoption programs, and utilization management.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

MedOne is a transparent, pass-through pharmacy benefit manager (PBM) that administers prescription drug benefits for self-funded employers and organizations nationwide. It combines formulary management, specialty drug cost containment, prior authorization, clinical care pathways (including opioid and behavioral health programs), mail order pharmacy, and a proprietary member portal under a PMPM administrative fee model with performance-based savings guarantees.

Product overview

MedOne operates as a full-service pharmacy benefit manager (PBM) offering a platform-plus-modules architecture. The core product is MedOne Pharmacy Benefit Management, which provides transparent, aligned, and performance-based pharmacy solutions through a pass-through pricing model. This core platform is supported by the myMedOne Member Portal, a digital experience enabling members to access prescription history, pricing lookup, prior authorizations, and mail order services. The offering is differentiated by the Clinical Care Path Suite, an 18-program clinical solution including the Opioid Care Path and Behavioral Care Path for targeted patient interventions. Specialty offerings include the RxAlly program for high-cost medication access and the Biosimilar Strategy for preferring low-cost biosimilars like Yusimry and Otulfi. MedOne Pharmacy Services provides mail order and specialty pharmacy capabilities with MedSync for medication synchronization. The MediSplit Program demonstrates value-based outcomes through partnerships. All components work together to deliver the company's mission of providing access to the most appropriate prescription at the most affordable price.

Differentiator

Problem solved

Functional benefit

Brands

• RxAlly: A proprietary suite of specialty cost containment solutions under the sub-brand RxAlly designed to help MedOne members gain access to high-cost medications.
• MedOne Pharmacy Services
• myMedOne
• Clinical Care Path Suite
• Opioid Care Path
• Behavioral Care Path
• MediSplit

Products and services

• MedOne Pharmacy Benefit Management (PBM) Full-service pharmacy benefit management offering transparent, aligned, and performance-based pharmacy benefit solutions on a pass-through model. Includes prior authorization, step therapy, formulary management, specialty cost containment, and 100% pass-through of rebates and discounts to plan sponsors.
• myMedOne Member Portal Proprietary digital member-facing portal for plan members to access prescription history, prior authorization tracking, drug pricing lookup, mail order enrollment, deductible/out-of-pocket progress, and direct member reimbursement submission.
• MedOne Pharmacy Services (Mail Order) On-site mail order and specialty pharmacy operated by MedOne, enabling direct-to-member shipment of maintenance and specialty medications in all 50 states, with MedSync medication synchronization.
• RxAlly Specialty Solutions Proprietary suite of specialty cost containment and access solutions designed to help MedOne members gain access to high-cost specialty medications through strategic partnerships and cost management programs.
• Clinical Care Path Suite An 18-program clinical solution suite forming the foundation of MedOne's benefit plans and corresponding savings strategies, including targeted programs such as Opioid Care Path (risk stratification and mitigation) and Behavioral Care Path (mental health support).
• Biosimilar Strategy Program Formulary strategy program preferring low-cost biosimilars as they enter the market, including Yusimry (Humira biosimilar) and Otulfi (Stelara biosimilar), with T0 specialty list placement and international sourcing options to drive rapid biosimilar adoption.
• Behavioral Care Path with Brightn Mental health support program targeting members on mental health medications and those seeking to improve mental wellness, combining MedOne's clinical drug-therapy problem identification with Brightn's AI-powered mobile mental wellness planning app.
• MediSplit Program Value-based pharmacy benefit initiative pairing Nanodropper's precision eye drop delivery device with MedOne's PBM network to reduce medication waste, improve adherence, and lower prescription drug costs for eye drop therapies.
• ROI Calculator Interactive online tool for channel partners and prospective clients to estimate potential pharmacy benefit savings by switching to MedOne, supporting sales conversations and partner enablement.

Quantifiable outcome

• 43.5% lower net PMPM spend than industry average
• +5 more outcomes

Named customers11 records

Segments4 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature4 records

Partnerships

Six partnerships are on record, tiered core, major and minor.

• NanodroppercoreStrategic or Co-development Partner · 2 April 2026MedOne and Nanodropper partnership on the MediSplit program, a value-based pharmacy benefit initiative pairing Nanodropper's precision eye drop delivery device with MedOne's PBM network. The program demonstrated 36% reduction in prescription drug costs, 100% of participants never missed doses due to running out or side effects, and $105 average savings per claim.
• Gateway Business Health CoalitionmajorChannel Partner/ Reseller/ Distributor · 26 February 2026Partnership to bring transparent PBM services to Gateway Business Health Coalition members. Collaborative effort to provide transparent pharmacy benefit solutions.
• BrightncoreStrategic or Co-development Partner · 27 February 2025Partnership to address mental health crisis through MedOne's Behavioral Care Path. Brightn's AI-powered app provides mental wellness support through personalized challenges, mood tracking, and journaling. MedOne's clinical team identifies members on mental health medications needing support. 60% of users report significant wellness improvements after 30 days.
• Mark Cuban Cost Plus Drug CompanycoreStrategic or Co-development Partner · 18 August 2023Integration providing MedOne members access to Cost Plus Drugs' pharmacy and pricing. All patient spend tracks to deductible and out-of-pocket maximum. Members can access YUSIMRY biosimilar at 90%+ less than HUMIRA list price. MedOne covers YUSIMRY as preferred medication for $569.25 plus fees.
• CoverMyMedscoreTechnology or Integration · 21 March 2023Integration with CoverMyMeds' network enabling electronic prior authorization (ePA) directly with prescribers, EHR systems, pharmacies, and pharmacy system vendors. Streamlines prior authorization process, reduces paperwork, and minimizes delay in claims processing.
• Tria HealthminorStrategic or Co-development PartnerPartnership for GLP-1 wellness support. Tria Health provides nutritional counseling, lifestyle coaching, and routine changes support for members on GLP-1 medications for weight management.

Scale indicators8 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• SmithRx: SmithRx is a transparent PBM targeting small and mid-sized self-funded employers with pass-through pricing and clinical programs. Comparable to MedOne in customer segment, pass-through model, and growth-stage profile.
• Navitus Health Solutions: Navitus is a non-profit, transparent PBM serving health plans, employers, and government programs with 100% pass-through of rebates. Directly comparable to MedOne in business model and target customer base, with broader plan sponsor coverage.
• Capital Rx: Capital Rx is a direct transparent PBM competitor offering a pass-through pricing model with proprietary technology (Judi) for self-funded employers and health plans. Closely comparable to MedOne in target customer, transparency positioning, and tech-enabled service model.
• RxBenefits: RxBenefits is a PBM and pharmacy benefit partner focused on self-funded employers and brokers. Comparable to MedOne in target customer (self-funded employers), broker channel emphasis, and emphasis on cost containment.
• MedImpact Healthcare Systems: MedImpact is an independent, transparent PBM serving health plans, employers, and government programs. Comparable to MedOne in transparent pricing philosophy and full-service PBM scope, with significantly larger scale.

Emerging players

• Mark Cuban Cost Plus Drug Company: Cost Plus Drugs is a direct-to-consumer pharmacy and MedOne's strategic partner for transparent drug pricing. It represents both a partnership and an emerging competitive vector that could disintermediate traditional PBMs.
• Tria Health: Tria Health is a medication therapy management and clinical solutions partner of MedOne for GLP-1 wellness support. Adjacent in clinical pharmacy services and overlapping in employer PBM buyer relationships.

Broad incumbents

• CVS Health (Caremark): CVS Caremark is the largest U.S. PBM and a core part of CVS Health. As a broad incumbent, it competes with MedOne for employer PBM contracts but operates a fundamentally different vertically integrated retail-clinic-PBM model rather than a transparent pass-through specialty.
• OptumRx (UnitedHealth Group): OptumRx is the largest PBM by prescription volume and part of UnitedHealth Group. It competes broadly for employer PBM business but is the focal point of much of the FTC and state PBM reform criticism that benefits transparent players like MedOne.
• Express Scripts (Cigna): Express Scripts is one of the Big 3 PBMs and a Cigna Group subsidiary. It serves large employer plans with scale advantages in rebate negotiation, contrasting with MedOne's transparent niche positioning.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/medone-pharmacy-benefit-solutions
• Facebookfacebook.com/MedOnePharmacyBenefitsSolutions

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 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 Medone Healthcare