What ProScript Pharmacy does

ProScript Pharmacy Management LLC is a family-owned pharmacy benefit manager (PBM) and licensed mail-order pharmacy founded in 2004 that exclusively administers self-funded pharmacy benefit plans sponsored by labor unions. The company designs pharmacy benefits for union health funds and operates four core service lines: Rx Benefit Plan Design (tailoring plan structures to fund needs), Member Support (dedicated toll-free helpline and per-fund email channels), Case Management (coordinating pharmacy and medical care with cost-containment strategies and a Special Investigative Unit for fraud, supported by membership in the National Health Care Anti-Fraud Association), and Mail Order Pharmacy (90–100 day fills of maintenance medications). Distribution is a hybrid model combining direct mail-order fulfillment (delivered via USPS and UPS, ~1 week turnaround) with a contracted retail pharmacy network for short-term fills of 30 days or less. The company's GTM is enterprise field sales directed at union Boards of Trustees, supplemented by in-person representation at union membership meetings.

Underlying technology is conventional PBM infrastructure: an e-prescribe system accepting submissions via e-scribe, phone, fax, or mail; a mail-order fulfillment system; and a third-party mobile patient portal called Rx365 (built by Liberty Software and distributed via Apple App Store and Google Play). There is no public API, SDK, or MCP integration in the source material, and no AI/ML capabilities are disclosed. Proscript is the customer-relationship layer to union Boards of Trustees while also providing consumer-facing member support.

Revenue is generated through three streams: managed-services administration fees for self-funded union plans; transaction-based fees (and copayments) on retail and mail-order prescription fills, structured with retail generics at up to a $5.00 copay, retail brands at a 10% copay, and mail-order generics free; and professional-services consulting revenue from helping other health funds design benefits, run network provider bidding, and prepare member communications. The business model is intentionally member-favorable (free mail-order generics, zero-fraud investigative layer, free generics strategy) as a cost-containment and loyalty lever for union plan sponsors. Geographic scope is domestic US, anchored in New Jersey (state of organization) and New York (authorized to do business), with no disclosed international or multi-state expansion.

Name

ProScript Pharmacy

Legal name

Proscript Pharmacy Management LLC

Website

https://proscriptpm.com

Company type

Private

Founded year

2004

Operating status

Operating

Headcount range

1–10 employees

Short description

ProScript Pharmacy Management LLC is a family-owned pharmacy benefit manager and mail-order pharmacy founded in 2004 that designs, administers, and dispenses prescription benefits exclusively for self-funded health plans sponsored by labor unions.

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), Pharmacies and Drug Retailers (456110), Pharmacies and Drug Retailers (45611)

SIC

Retail-Drug Stores And Proprietary Stores (5912), 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), Copay Assistance, Patient Support & Affordability Programs (HLAEAKAI), Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI)

Keywords

• Pharmacy benefit management
• Mail order pharmacy
• Prescription benefit plans
• Case management services
• Union health fund administration

Headquarters

HQ city

Staten Island

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Pharmacy Benefit Management Services: Administration of self-funded pharmacy benefit plans for union-sponsored health funds. Revenue derived from plan administration fees, prescription processing, and cost containment services including specialty drug negotiation and case management.
2. Mail Order Prescription Fulfillment: Dispensing maintenance medications through mail order pharmacy. Revenue generated through prescription transaction fees and copayments. Offers free generic drugs through mail order as a cost containment strategy.
3. Consulting Services: Consulting with other health funds to help achieve pharmaceutical cost savings. Services include recommending plan structures, designing benefits, preparing member communications, providing quarterly management reports, and conducting network provider bidding processes.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

ProScript Pharmacy is a pharmacy benefit manager and licensed mail-order pharmacy that designs, administers, and delivers self-funded prescription drug benefit plans for labor union-sponsored health and welfare funds. The company manages mail-order fulfillment of 90–100-day maintenance medications, provides case management with cost-containment and specialty drug negotiation, and offers consulting to help other health funds design plans and reduce pharmacy spend.

Product overview

Proscript Pharmacy Management operates as a pharmacy benefit manager focused on union-sponsored health funds, offering a unified suite of services built around its core Mail Order Pharmacy and Case Management capabilities. The portfolio consists of four interconnected service lines: Rx Benefit Plan Design (which tailors pharmacy benefits to union fund needs), Member Support (providing a toll-free helpline and enrollment assistance), Case Management (coordinating pharmacy and medical care with cost-containment strategies), and Mail Order Pharmacy (fulfilling 90–100 day maintenance medication supplies). The RX365 mobile app serves as the consumer-facing digital portal, enabling members to refill prescriptions, track deliveries, and manage their medications. The company also provides consulting services to help other health funds optimize pharmacy spend. No public API, SDK, or third-party product integrations were identified in the source material.

Differentiator

Problem solved

Functional benefit

Products and services

• Mail Order Pharmacy Full-service mail-order pharmacy that manages and fulfills all maintenance prescriptions for union health fund members, offering 90-100 day supplies with quick turnaround times (approximately one week) from prescription reception to delivery.
• Rx Benefit Plan Design Custom pharmacy benefit plan design service that encompasses every necessary detail of pharmacy coverage and tailors it to the specific needs of union health funds, including plan structure recommendations and member communications.
• Case Management Proactive and personalized prescription and healthcare management coordinated across pharmacy and medical teams, focused on cost containment, specialty drug negotiation, Letter of Medical Necessity evaluation, and healthcare fraud identification through a Special Investigative Unit.
• Member Support Staffed member support service providing a dedicated toll-free line to assist union members and dependents with benefits, eligibility, prescriptions, package tracking, copayments, authorizations, and general pharmacy questions.
• Rx365 Mobile App Patient portal mobile application available on Apple App Store and Google Play that allows union members and their dependents to manage prescriptions, refill medications, view profile history, track packages, and communicate directly with the pharmacy.

Quantifiable outcome

• 90-100 day supply of maintenance medications vs. 30-day retail
• +2 more outcomes

Named customers2 records

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Two partnerships are on record, tiered core and supporting.

• CrossroadscoreStrategic or Co-development PartnerProscript works closely with Crossroads to ensure medical treatment and prescription therapy work together hand-in-hand. This coordination between medical case management and pharmacy services provides patients with comprehensive all-around care while remaining cost-effective for the health fund. This partnership is described as unusual compared to other benefit plans.
• Retail Pharmacy NetworksupportingChannel Partner/ Reseller/ DistributorProscript coordinates access to a network of retail pharmacies for the purpose of short-term prescription fills (30 days or less), including control drugs, antibiotics, and trial period fills of maintenance medications. Members can use any retail pharmacy in the network with their Proscript ID card.

Scale indicators2 records

Recent moves5 records

Expansion highlights3 records

Direct peers

• BeneSys: BeneSys is a third-party administrator and PBM specifically focused on Taft-Hartley and multi-employer union health and welfare plans. Most directly comparable peer: same self-funded union niche, similar consulting-and-administration service model to union Boards of Trustees, and comparable size.
• MedImpact Healthcare Systems: MedImpact is an independent, mid-sized PBM serving health plans, employers, and government programs with transparent PBM services. Directly comparable as an independent PBM offering self-funded plan administration, mail-order, and specialty pharmacy in similar mid-market accounts.
• Elixir Pharmacy Solutions: Elixir is an independent PBM and mail-order pharmacy focused on self-funded employer and union health plans. Comparable on mail-order dispensing, formulary management, and clinical cost containment offerings aimed at similar mid-market self-funded plan sponsors.
• SmithRx: SmithRx is a tech-enabled, transparent PBM targeting self-funded employers including mid-sized plans. Comparable on the self-funded plan administration model with a focus on cost containment, although SmithRx typically focuses on broader employer segments rather than unions.
• Navitus Health Solutions: Navitus is a mid-sized independent PBM focused on transparent, pass-through pricing for self-funded employer, union, and government plans. Comparable PBM model serving self-funded plans with mail-order and specialty pharmacy capabilities.
• RxBenefits: RxBenefits is a PBM consultant and outsourced PBM services partner for smaller self-funded employers, brokers, and benefits advisors. Comparable as a specialist serving self-funded plan sponsors through a consulting-led model similar to ProScript's direct-to-trustee relationships.

Broad incumbents

• Express Scripts (Cigna Group): Express Scripts is one of the three largest U.S. PBMs, serving tens of millions of members including union-sponsored plans. Operates at vastly greater scale than ProScript but competes for the same self-funded employer and union pharmacy-benefit spend.
• CVS Caremark (CVS Health): CVS Caremark is a top-three U.S. PBM embedded within a vertically integrated pharmacy retailer and insurer. Competes for the same self-funded plan administration and mail-order pharmacy business that ProScript provides to its union clients.
• OptumRx (UnitedHealth Group): OptumRx is the largest U.S. PBM by prescription volume, part of UnitedHealth Group's integrated payer-PBM-provider stack. A broad incumbent peer pursuing the same self-funded employer and union clients with significant scale advantages.

Emerging players

• Capital Rx: Capital Rx is a tech-forward PBM operating a transparent, fully adjudicated pharmacy platform (Judi) for self-funded employers, plans, and unions. Comparable on the self-funded employer/unions service line, but with a meaningfully different, modern technology foundation than ProScript's stack.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/proscriptpharmacy
• LinkedInlinkedin.com/company/proscript-pharmacy-management-llc

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 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 ProScript Pharmacy