ScriptGuideRX

What ScriptGuideRX does

ScriptGuideRX, Inc. (SGRX) is a privately-held Pharmacy Benefit Manager (PBM) and Third-Party Administrator (TPA) founded in 2001 and headquartered in Grosse Pointe Park, Michigan, with additional offices in Detroit and Nashville. The company operates an in-house claims processing and administration platform with real-time point-of-sale adjudication, eligibility management, national pharmacy network management across 60,000+ locations, 24/7 PharmTech call center support, and clinical services (Pharmacy & Therapeutics, Formulary, and Utilization Management). It is certified by the National Minority Supplier Development Council as a Minority Business Enterprise (MBE) and is HIPAA-compliant as a Business Associate.

SGRX monetizes through three primary streams: (1) all-inclusive PBM administrative fees on a Per Member Per Month (PMPM) or Per Claim basis with no ancillary charges (contrasted with competitors who stack fees for Prior Authorization, ad hoc reporting, and case management); (2) TPA services for medical and pharmacy benefits administration for private and public entities; and (3) managed-services 340B Administration covering contract pharmacy, inventory, compliance, and reporting, plus a transaction-fee consumer discount program (SGRXSaves) offering up to 80% prescription discounts at 30,000+ participating pharmacies. Reported outcomes include a 15-20% reduction in net drug spend for new clients without plan design changes and negative-to-single-digit net drug cost trend rates for 17 consecutive years.

The go-to-market is sales-led, targeting employer groups, health plans, state drug assistance programs (including ADAPs for Louisiana, Georgia, Michigan, and others), Medicaid programs (Guam, USVI), nonprofits, and brokers, supplemented by a 2024 strategic partnership with PharMor to expand pharmacy-network distribution. Customer segments disclosed are predominantly public-sector and government clients, with named logos spanning Wayne County HealthChoice, HealthChoice of Michigan, Louisiana HAP, GADAP, Michigan MIDAP, Guam Medicaid, and USVI Medicaid.

Name

ScriptGuideRX

Legal name

ScriptGuideRX, Inc.

Website

https://sgrxhealth.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

11–50 employees

Short description

ScriptGuideRX is a privately-held Pharmacy Benefit Manager and Third-Party Administrator founded in 2001, serving employer groups, health plans, state drug assistance programs, and Medicaid programs through in-house claims processing and a 60,000+ pharmacy network.

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)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL)

akta.pro secondary industries

340B Program Administration & Support (HLAEAKAJ), Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK), Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Copay Assistance, Patient Support & Affordability Programs (HLAEAKAI)

Keywords

• Pharmacy benefit management
• Claims adjudication services
• 340B administration
• Drug assistance programs
• Third-party administrator

Headquarters

HQ city

Grosse Pointe Park

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Pharmacy Benefit Management Administrative Fees: SGRX offers all-inclusive administrative Per Member Per Month (PMPM) or Per Claim fee as opposed to a combination of administrative fee and ancillary fees. Ancillary fees typically include charges for items such as Prior Authorization, Adhoc Reporting, Case Management.
2. Third-Party Administrator (TPA) Services: TPA services for medical and pharmacy benefits administration for private and public entities.
3. 340B Administration Services: Quality 340B administration program management services including contract pharmacy management, inventory management, compliance, and customized reporting.
4. Prescription Savings Program (SGRXSaves): Free prescription savings program providing discounts; not an insurance plan. Generates revenue through pharmacy network participation and discount card utilization.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels6 records

Core offering

ScriptGuideRX (SGRX) is a pharmacy benefit management (PBM) and third-party administrator (TPA) that delivers in-house claims processing, real-time point-of-sale adjudication, and management of a 60,000+ pharmacy network for employer groups, health plans, state drug assistance programs, Medicaid programs, and nonprofit organizations. The company administers state ADAP and Medicaid programs (e.g., Louisiana, Georgia, Michigan, Guam, USVI), 340B drug pricing programs, and the SGRXSaves consumer discount card, supported by clinical services, medication therapy management, and 24/7 PharmTech call center support.

Product overview

ScriptGuideRX (SGRX) is an independent Pharmacy Benefit Management (PBM) and Third-Party Administrator (TPA) company offering a comprehensive suite of healthcare administration services since 2001. The core offering is its full-service PBM platform, which includes in-house claims processing, a national pharmacy network of over 60,000 locations, clinical services, and specialty pharmacy support. Built on this core platform, SGRX offers integrated add-on modules including 340B Administration for drug assistance programs, Medicaid Programs management, Medication Therapy Management, Insurance Benefit Management, and Healthcare Consulting services. Specialized programs include the SGRXSaves prescription savings card (up to 80% discounts), HealthChoice of Michigan for Michigan beneficiaries, Wayne County Senior Prescription Savings Program, and Non-Opioid Support. The company also administers multiple State Drug Assistance Programs (ADAP) across multiple states. SGRX differentiates through transparent, all-inclusive Per Member Per Month (PMPM) or Per Claim pricing rather than combining administrative and ancillary fees.

Differentiator

Problem solved

Functional benefit

Brands

• SGRXSaves: A prescription savings program providing up to 80% discounts off pharmacy retail prices at over 30,000 participating pharmacy locations nationwide. Not an insurance plan.
• HealthChoice of Michigan

Products and services

• Pharmacy Benefit Management (PBM)
• Third-Party Administrator (TPA) Services
• 340B Administration
• SGRXSaves Prescription Savings Program
• HealthChoice of Michigan
• Wayne County Health Choice Senior Prescription Savings Program
• Non-Opioid Support Program
• Medicaid Programs Administration
• State Drug Assistance Programs (ADAP) Administration
• Healthcare Consulting

Quantifiable outcome

• 15-20% decrease in net drug spend for new clients without changes to existing plan design
• +1 more outcomes

Named customers7 records

Segments6 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Four partnerships are on record, tiered core and minor.

• PharMorcoreStrategic or Co-development Partner · 1 February 2024SGRX partnered with PharMor in February 2024 to expand pharmacy benefit management services and prescription savings programs through PharMor's pharmacy network and retail presence.
• Wayne County HealthChoicecoreStrategic or Co-development PartnerWayne County HealthChoice partners with SGRX to administer the Wayne County Senior Prescription Savings Program, providing free prescription savings cards to eligible Wayne County seniors aged 55+.
• Louisiana Department of HealthcoreStrategic or Co-development PartnerSGRX partners with the Louisiana Department of Health to administer the Louisiana Health Access Program (LA HAP), providing HIV/AIDS medication and insurance services through ADAP funding.
• National Minority Supplier Development Council (NMSDC)minorOthersSGRX is certified by the National Minority Supplier Development Council as a Minority Business Enterprise (MBE).

Scale indicators6 records

Recent moves6 records

Direct peers

• Navitus Health Solutions: Pass-through, transparent PBM serving health plans, employers, and government programs including state Medicaid clients—a near-direct peer in business model, transparency stance, and government footprint.
• RxBenefits: PBM partner for benefits brokers serving mid-market employers, with transparent pass-through pricing—competing for similar employer-group distribution channels via broker partnerships.
• CerpassRx: Independent PBM providing transparent pharmacy benefit administration for employers, health plans, and government programs—comparable size and go-to-market to SGRX.
• ProCare Rx: Independent PBM offering PBM services, MTM, and specialty pharmacy to small/mid employers and government clients—comparable size and customer mix to SGRX.
• SmithRx: Tech-forward, transparent PBM serving self-funded employers with a modern platform and pass-through pricing—directly competing for the same employer-group RFPs SGRX targets.
• MedImpact Healthcare Solutions: Independent, mid-sized PBM competing on transparency and flexible pricing for health plans, employers, and government programs—closely matching SGRX's positioning as a non-vertically-integrated alternative to the top-three PBMs.
• Capital Rx: Cloud-native, transparent PBM (Judi Health platform) targeting health plans and employers with modern technology and aligned pass-through economics—comparable in mission and target segment to SGRX.

Broad incumbents

• Express Scripts (The Cigna Group): Top-three U.S. PBM within Cigna, competing across employer, health plan, and government accounts with mail-order, specialty, and Accredo capabilities far exceeding SGRX's footprint.
• CVS Caremark (CVS Health): Largest U.S. PBM and part of vertically integrated CVS Health; competes for the same employer, health plan, and government contracts but at far greater scale and with owned retail/specialty pharmacy assets.
• OptumRx (UnitedHealth Group): PBM arm of UnitedHealth Group and the largest PBM by prescription volume; competes broadly across all customer segments SGRX serves, leveraging data and scale advantages.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/SGRXhealth
• LinkedInlinkedin.com/company/sgrxhealth
• Xx.com/scriptguiderx

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 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 ScriptGuideRX