What PerformRX does

PerformRx is a privately held pharmacy benefit manager (PBM) headquartered at 200 Stevens Drive in Philadelphia, Pennsylvania, founded in 1999 to serve Medicaid managed care plans and at-risk member populations. The company has operated Medicare Part D pharmacy benefit services since the federal program's inception in 2006 and now also serves commercial payers and employer groups, with a customer roster that spans Pennsylvania, Delaware, North Carolina, South Carolina, Louisiana, Florida, Michigan, and California.

PerformRx delivers its services through a portfolio of proprietary technology platforms and clinical programs. The core technology stack includes PerformPA® (online prior authorization tool), PerformPRO® (Drug Therapy Management platform for medication-related problem identification), PerformSpecialty® (a fully owned and integrated specialty pharmacy launched in 2014 for high-touch conditions such as Hepatitis C, HIV, multiple sclerosis, hemophilia, and oral oncology), and PerformPBI™ (pharmacy benefit intelligence portal). Clinical offerings include URAC-accredited Drug Therapy Management, formulary management, drug utilization review, utilization management, Medicare Part D support including Star ratings optimization, and Social Determinants of Health screening through a retail-MTM partnership with Outcomes™. The company holds URAC accreditations for Drug Therapy Management and PBM, and NCQA accreditation for Utilization Management, with more than 80% of staff holding pharmacy backgrounds.

The revenue model is enterprise PBM services sold directly to health plan clients via personalized account teams, structured as either full-PBM engagements or a la carte modular offerings. Pricing is not publicly disclosed and is negotiated per client. A 2023 pilot with Xact Laboratories and a Michigan Medicaid plan extended the clinical portfolio into pharmacogenomics. Multiple named customers are AmeriHealth Caritas affiliates, and the PerformRx careers portal is hosted on the AMERINC Taleo instance, suggesting structural affiliation with the AmeriHealth Caritas family despite the absence of a formally disclosed parent company.

Name

PerformRX

Legal name

PerformRx

Website

https://performrx.com

Company type

Private

Founded year

1999

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

PerformRx is a privately held Philadelphia-based pharmacy benefit manager founded in 1999, serving Medicaid, Medicare Part D, and commercial health plans with proprietary PBM technology, clinical programs, and an owned specialty 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)

akta.pro primary industry

Formulary Management & Clinical Pharmacy Programs (HLAEAKAA)

akta.pro secondary industries

Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI), PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL), Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Prior Authorization, Utilization Management & Step Therapy (HLAEAKAG), Claims Processing, Adjudication & Payment Integrity (HLAEAKAC), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD)

Keywords

• Pharmacy benefit management
• Drug therapy management
• Specialty pharmacy services
• Prior authorization tools
• Medicare part d support

Headquarters

HQ city

Philadelphia

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

Revenue model

1. Pharmacy Benefit Management (PBM) Services: PerformRx provides comprehensive PBM services including formulary management, drug utilization review, utilization management, pharmacy network management, and clinical services to health plans, Medicaid programs, Medicare Part D plans, commercial payers, and employer groups. Revenue is generated through management fees, pharmacy claims processing, and clinical program fees.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core offering

PerformRx is a pharmacy benefit manager that provides comprehensive PBM services including formulary management, drug utilization review, utilization management, pharmacy network management, prior authorization, and clinical programs such as Drug Therapy Management to health plans, Medicaid programs, Medicare Part D plans, commercial payers, and employer groups. The company delivers both full-PBM and modular a la carte engagements supported by proprietary web-based platforms (PerformPA, PerformPRO, PerformPBI) and a fully owned specialty pharmacy subsidiary, PerformSpecialty.

Product overview

PerformRx is a Pharmacy Benefit Manager (PBM) offering a portfolio of technology and clinical service products. The core technology offerings include PerformPA® (prior authorization tool) and PerformPRO® (Drug Therapy Management platform), along with PerformSpecialty® (fully integrated specialty pharmacy launched in 2014) and PerformPBI™. These are complemented by clinical services including URAC-accredited Drug Therapy Management, Clinical Services (formulary management, drug utilization review, utilization management), Medicare Part D Support, and Client Support Services. The company operates a clinical-first approach with over 80% of staff having pharmacy backgrounds, serving Medicaid, Medicare Part D, commercial payers, and employer groups since its founding in 1999.

Differentiator

Problem solved

Functional benefit

Brands

• PerformSpecialty: Fully owned and integrated specialty pharmacy offering medication, support and adherence programs for complex conditions including Hepatitis C, HIV, rheumatoid arthritis, multiple sclerosis, hemophilia, and others.
• PerformPA
• PerformPRO

Products and services

• PerformPA® An easy-to-use online pharmacy prior authorization (PA) tool built by PerformRx clinicians that walks users through the PA process step-by-step with a tab-based guide. It is fully compliant with all state and federal laws and is offered to clinicians and prescribers as part of PerformRx's PBM technology portfolio.
• PerformPRO® A web-based Drug Therapy Management (DTM) platform used by PerformRx to identify and proactively correct medication-related problems for DTM-enrolled members. Supports health plans in meeting CMS requirements, calculating drug adherence, identifying care gaps, recommending additional therapy, identifying drug safety concerns, generating custom reports, and delivering targeted or mass member notifications across mail, fax, phone, and internet.
• PerformSpecialty® A fully owned and integrated specialty pharmacy providing high-touch specialty medication services, support programs, and adherence programs for complex conditions including Hepatitis C, HIV, rheumatoid arthritis, multiple sclerosis, hemophilia, psoriatic arthritis, Crohn's disease, and oral oncology. Direct access to the specialty pharmacy supply chain reduces gaps in care for PerformRx client health plan members.
• PerformPBI™ A PerformRx technology platform branded as PerformRx Pharmacy Benefit Intelligence (PBI), accessible at performpbi.amerihealthcaritas.com, used for pharmacy benefit information management as part of PerformRx's PBM technology portfolio.
• Drug Therapy Management (DTM) A URAC-accredited Drug Therapy Management service that optimizes medication regimens for highest risk members, including those at risk for non-adherence, inappropriate medication use, and adverse drug events. Includes comprehensive medication reviews, member outreach, disease state management, and case management support.
• Clinical Services A bundle of clinical services designed to improve member health, reduce total cost, and provide clients with personal service. Includes Formulary Management, Drug Utilization Review, Utilization Management, and Pharmacy and Therapeutic (P&T) committee support for health plan clients.
• Medicare Part D Support PBM services for Medicare Part D plans including medication therapy management, Star ratings support, and CMS guidance and support. PerformRx has managed Medicare Part D pharmacy benefits since the program's inception in 2006.
• Specialty Pharmacy Services Specialty pharmacy services integrated with disease state management for conditions including Hepatitis C, HIV, rheumatoid arthritis, multiple sclerosis, hemophilia, psoriatic arthritis, Crohn's disease, and oral oncology.
• Client Support Services Personalized account teams, pharmacy network access, and customer care centers tailored to each health plan client's benefits structure and member population, delivered as part of PerformRx's full-PBM or a la carte engagements.

Quantifiable outcome

• Over 14,000 patients engaged annually through CMR programs; over 22,000 medication-related problems identified in 2021, with more than 10,000 successfully resolved.
• +3 more outcomes

Named customers15 records

Segments5 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Two partnerships are on record, tiered core.

• Xact LaboratoriescoreStrategic or Co-development Partner · 1 January 2023In early 2023, PerformRx launched a pilot pharmacogenomics (PGx) program in collaboration with Xact Laboratories and a Michigan Medicaid plan. The initiative integrated pharmacogenomic testing into a Drug Therapy Management (DTM) program for members with cardiovascular conditions, aiming to optimize medication therapy and reduce adverse drug events through personalized medicine.
• Outcomes™ (Community Pharmacy MTM Partner)coreTechnology or IntegrationPerformRx integrated SDOH assessments into its retail-level Medication Therapy Management (MTM) program in partnership with Outcomes™. This program prompts retail pharmacists to offer appropriate members an SDOH assessment based on the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) screening tool, enabling community pharmacists to identify and address SDOH barriers.

Scale indicators6 records

Recent moves5 records

Expansion highlights4 records

Direct peers

• Humana Pharmacy Solutions: PBM owned by Humana with a strong Medicare Part D focus. Comparable to PerformRx in Medicare and MAPD/D-SNP service offerings, specialty pharmacy, and Star ratings support.
• MedImpact Healthcare Systems: Independent, pharmacist-founded PBM serving health plans, employers, and government programs with formulary management and specialty pharmacy. Highly comparable to PerformRx's clinical-first model and target customer mix.
• Elixir Rx Solutions: Mid-market PBM serving Medicare, Medicaid, and commercial plans with formulary, clinical programs, and specialty pharmacy. Comparable scale and customer profile to PerformRx.
• Navitus Health Solutions: Independent, pass-through PBM focused on transparency and clinical programs for Medicaid, health plans, and employer groups. Closely matches PerformRx's boutique clinical-culture positioning and government-plan skew.
• Prime Therapeutics: Owner-owned PBM serving primarily Blue Cross Blue Shield plans across Medicaid, Medicare, and commercial lines. Direct competitor in the boutique-to-mid-market PBM space with similar focus on government programs.
• Magellan Rx Management: PBM and specialty pharmacy management division focused on Medicaid, Medicare, and commercial plans with strong clinical and utilization management offerings — directly overlapping with PerformRx's service portfolio.

Broad incumbents

• Express Scripts (Evernorth / Cigna): One of the three largest U.S. PBMs, serving commercial, Medicare, and Medicaid plans with formulary management, specialty pharmacy, and mail order. Directly comparable to PerformRx's core PBM services, but at vastly greater scale and vertically integrated with Cigna's payer arm.
• OptumRx: PBM owned by UnitedHealth Group, the largest U.S. PBM by prescription volume. Directly comparable PBM services for Medicaid, Medicare, and commercial plans, with deeper payer integration through UnitedHealthcare.
• CVS Caremark: PBM arm of CVS Health, one of the Big-3 PBMs. Offers formulary management, specialty, and mail-order pharmacy similar to PerformRx, with the added advantage of CVS retail and Aetna payer integration.

Emerging players

• BioPlus Specialty Pharmacy: Specialty pharmacy focused on complex conditions including oncology, hepatitis C, and autoimmune disease. Comparable to PerformSpecialty's high-touch specialty offering, though more focused on direct dispense than full PBM integration.

Market position

Strengths5 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/performrx_
• LinkedInlinkedin.com/company/performrx

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries1 record

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 PerformRX