CPESN

What CPESN does

CPESN USA is a privately held Clinically Integrated Network of approximately 3,500 independent community pharmacies organized into 44 local networks across 47 states and the District of Columbia. Founded in 2016 and headquartered in Garner, North Carolina as CPESN USA, LLC, the company serves as a contracting and care coordination intermediary that enables independent pharmacies to participate in value-based care arrangements with payers, health plans, and PBMs through single national contracts. The organization coordinates care delivery, documentation, quality reporting, and outcomes measurement across its member pharmacies using the proprietary EngageRx® Services framework and eCare Plans documentation system, with local Managing Network Facilitators supporting operations within each state network.

The company operates a B2B2C go-to-market model. Its primary customers are payers and health plans—Humana Healthy Horizons, Elevance Health/CarelonRx, Magnolia Health, CareSource, HMSA, Highmark Wholecare, and state Medicaid MCOs—who gain access to the entire pharmacy network through a single contract. CPESN enables provider-status clinical billing for network pharmacists, value-based contracting tied to quality measures such as HEDIS gap closures and chronic disease outcomes, and participation in federal programs including the CDC Federal Retail Pharmacy Partnership and CMS Rural Health Transformation Programs. Revenue flows through a mix of value-based contracting, provider-status clinical billing, special purpose programs, and marketplace offerings. Documented outcomes include 33% reduction in inpatient admissions and 30% reduction in hospitalization costs for high-risk Medicaid members engaged with CPESN pharmacies through the Elevance Health/CarelonRx collaboration, validated by the Elevance Health Public Policy Institute.

CPESN USA has a lean corporate team of 11-50 employees led by Executive Director Troy Trygstad, with local execution handled through Managing Network Facilitators across 44 regional networks. Technology infrastructure includes the EngageRx® Services quality framework, eCare Plans documentation, SAS-based data aggregation and reporting (which achieved perfect CDC validation scores), and a recent AI-powered Remote Care Initiative partnership with Truentity Health. Notable recognition includes the 2024 SAS Customer Recognition Award in the Community Uplift Category, the 2024 NCPA Calvin J. Anthony Lifetime Achievement Award (Robert Greenwood), and the 2024 Civitas Networks for Health Health Equity Champion Award with Telligen.

Name

CPESN

Legal name

CPESN USA, LLC

Website

https://cpesn.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

11–50 employees

Short description

CPESN USA is a Clinically Integrated Network of 3,500 independent community pharmacies across 47 states, enabling independent pharmacies to participate in value-based care contracts with payers and health plans through single national contracts and standardized clinical service delivery.

Ownership category

akta.pro rank

Product category

Community Pharmacy Services

NAICS

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

SIC

Services-Health Services (8000)

akta.pro primary industry

Pharmacy Network Contracting & Management (HLAEAKAB)

akta.pro secondary industries

Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN)

Keywords

• Community pharmacy network
• Value-based pharmacy care
• Medication management services
• Clinical pharmacy integration
• Pharmacy quality outcomes

Headquarters

HQ city

Cary

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, Others

Revenue model

1. Value-Based Care Contracting: CPESN USA enables pharmacies to participate in value-based care arrangements with payers and health plans. A single national contract with a payer opens access to all 3,500 network pharmacies for delivering clinical services. Pharmacies earn reimbursement based on quality measures (HEDIS gap closures), patient outcomes (e.g., diabetes management, blood pressure control), and care coordination activities. The model combines stable dispensing payments, billing capabilities for enhanced clinical services, and value-based incentives.
2. Provider-Status Clinical Billing: Network pharmacists bill directly for clinical services as providers under payer contracts, enabling independent pharmacies to receive reimbursement for services such as medication therapy management, chronic care management, point-of-care testing, comprehensive medical reviews, and immunization services.
3. COVID-19 Vaccine Administration Revenue: CPESN pharmacies participated in the CDC Federal Retail Pharmacy Partner program, administering nearly 6.8 million COVID-19 vaccinations. This generated $270M in additional revenue for participating pharmacies and enabled access to federal vaccine allocation.
4. Rural Health Transformation Program Participation: CPESN networks are positioned to participate in state-level CMS Rural Health Transformation Programs, supporting chronic disease management, remote patient monitoring, behavioral health, and care coordination — generating revenue through service-based contracts and care delivery fees.
5. Special Purpose Programs / Marketplace: Special Purpose Programs are offered for pharmacies wishing to pursue entrepreneurial opportunities in alternative dispensing and non-dispensing service and revenue models. Available through the CPESN Marketplace platform.

Go-to-market motion1 record

Distribution channels6 records

Marketing channels6 records

Core offering

CPESN USA operates a Clinically Integrated Network of 3,500 community pharmacies organized into 44 local networks across 47 states and the District of Columbia. The company contracts nationally with payers, health plans, and PBMs to deliver value-based clinical pharmacy services—spanning medication therapy management, chronic disease management, point-of-care testing, immunizations, and care gap closure—through its standardized EngageRx Services framework. Network pharmacies earn reimbursement through provider-status billing for clinical services and value-based incentives tied to quality measures and patient outcomes.

Product overview

CPESN USA operates as a clinically integrated network of community pharmacies organized into 44 local networks across 47 states and the District of Columbia. The portfolio consists of EngageRx Services (quality-standardized care delivery), the Pharmacy Quality Rewards Program (value-based care with Humana), Remote Care Initiative (AI-powered remote services with Truentity Health), CPESN Community Health (health equity initiatives), and supporting services including Business Intelligence and Medical Billing Supports. The network enables pharmacies to deliver enhanced clinical services through single contracts with payers, generating new revenue streams beyond traditional dispensing while demonstrating measurable patient outcomes.

Differentiator

Problem solved

Functional benefit

Brands

• EngageRx Services: Quality standards and services delivered consistently across CPESN pharmacy networks
• Remote Care Initiative
• CPESN Community Health
• Rural Health Transformation
• Community Connected
• Special Purpose Programs

Quantifiable outcome

• 33% reduction in inpatient admissions for high-risk Medicaid members engaged with CPESN pharmacies (2-year pilot with Elevance Health/CarelonRx)
• +6 more outcomes

Named customers12 records

Segments5 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

14 partnerships are on record, tiered core, strategic and flagship.

• Humana Healthy HorizonscoreStrategic or Co-development Partner · 1 April 2026Humana Healthy Horizons (Humana's Medicaid managed care division) partnered with CPESN USA to launch the Pharmacist Quality Rewards program in Ohio in April 2026. The value-based program compensates community pharmacists based on quality measures related to medication management, patient engagement, and chronic condition outcomes for Humana's Medicaid members. The program rewards pharmacies for meeting NCQA HEDIS quality measures including blood pressure control and glycemic status assessments. Humana and CPESN USA plan to expand the program to additional markets if the Ohio pilot proves successful.
• Elevance Health / CarelonRxcoreStrategic or Co-development PartnerMulti-network, multi-state collaboration since 2021 to improve health outcomes for millions of Americans. Elevance Health's PBM CarelonRx collaborates with CPESN's independent community pharmacists who intervene with patients at the local level. Results include 33% reduction in inpatient admissions, 30% reduction in hospitalization costs, and 18% reduction in ED costs for engaged Medicaid members. Currently active in 11 CPESN networks, expanding to additional states. First paper published October 2023, second paper published September 2024.
• Truentity HealthstrategicTechnology or IntegrationTruentity Health's AI-powered healthcare platform was selected by CPESN USA to participate in its Remote Care Initiative, expanding pharmacist-led remote care services across the U.S. The collaboration aims to improve patient outcomes and pharmacy economics by enabling pharmacies to deliver reimbursable chronic care services through scalable workflows.
• Centers for Disease Control and Prevention (CDC)flagshipStrategic or Co-development PartnerCPESN USA was selected as one of the Federal Retail Pharmacy Partners to administer COVID-19 vaccines via local pharmacies during the pandemic. CPESN's data team ingested vaccine administration data from 2,000 pharmacies, created CDC-specified reports, and uploaded them daily, achieving 10 out of 10 on all CDC data quality metrics. The program enabled local independent pharmacies to access federal vaccine allocation. Program closed end of 2023, with nearly 6.8 million vaccinations administered and $270M in pharmacy revenue generated.
• Cost Plus DrugsstrategicGTM or Marketing PartnerCPESN USA and Cost Plus Drugs entered an agreement weeks after Mark Cuban's video keynote at CPESN's Mid-Year Leadership Event. The program will initiate with the CPESN Iowa network with a goal of identifying employer customers for Cost Plus + CPESN pharmacy-led healthcare services. Mark Cuban discussed pharmacy disruption, PBM reform, pricing transparency, and the cash-pay segment during his keynote.
• TelligenstrategicStrategic or Co-development PartnerTelligen and CPESN Networks were recognized with the Health Equity Champion Award at Civitas Networks for Health's 2024 Annual Conference for efforts to increase vaccination rates and education at more than 1,000 nursing homes across Iowa, Colorado, Oklahoma, and Illinois. This represents a collaborative public health initiative between the quality improvement organization and CPESN pharmacy networks.
• Takeda PharmaceuticalsstrategicStrategic or Co-development PartnerCPESN Community Health was highlighted in Takeda's Community Health Impact Report, recognizing community-based pharmacy care as a critical driver of health equity and improved outcomes. The report showcases organizations advancing innovative, patient-centered approaches — particularly for people with chronic conditions and communities with historically faced barriers to access.
• SASstrategicTechnology or IntegrationCPESN USA was recognized with the 2024 SAS Customer Recognition Award in the Community Uplift Category for making an impact in their community using SAS products. CPESN uses SAS products for data aggregation, analytics, and reporting — including achieving perfect CDC validation scores for vaccine administration data reporting.
• Magnolia Health (Mississippi Medicaid MCO)coreStrategic or Co-development PartnerMagnolia Health renewed and expanded its CPESN Mississippi Medicaid MCO program. CPESN Mississippi pharmacies reported more than 200 encounters with 97 Medicaid plan members over seven months. Services include Med Sync programs for asthma, ADHD, and diabetes patients, with expansion to include COPD patients and HbA1c collection for diabetes management.
• CareSource (Ohio Medicaid MCO)coreStrategic or Co-development PartnerCareSource Medicaid MCO statewide contract with CPESN Ohio allows all network pharmacists to provide and bill for clinical services as needed by their patients under provider-status arrangements.
• HMSA (Hawaii Medical Services Association)strategicStrategic or Co-development PartnerHMSA renewed a two-year adherence contract with CPESN Hawaii for a gap closure program focused on increasing adherence for Medicare patients. The renewal adds an annual administrative payment to the fee-for-services program.
• Highmark Wholecare (Pennsylvania Medicaid MCO)strategicStrategic or Co-development PartnerHighmark Wholecare and the Pennsylvania Pharmacists Care Network (CPESN Pennsylvania) launched the MOMENTUM Maternal Health Program with hundreds of community-based pharmacies across Pennsylvania, bringing real support closer to home for Medicaid members.
• Mobility HealthstrategicStrategic or Co-development PartnerMobility Health partnership began with CPESN Ohio and expanded nationally to all CPESN pharmacies. The partnership supported network pharmacies in providing PCR COVID-19 testing. CPESN Ohio's initial success led to the national expansion of the relationship.
• Centers for Medicare & Medicaid Services (CMS) — Rural Health Transformation ProgramcoreStrategic or Co-development PartnerCPESN networks are participating in CMS-funded state Rural Health Transformation Programs across multiple states including New Mexico, Oklahoma, Arkansas, Missouri, Nebraska, West Virginia, Wisconsin, and Wyoming. The programs focus on chronic disease management, remote patient monitoring, behavioral health, and care coordination in rural communities. Wyoming specifically references scope flexibility for pharmacists and clinically integrated care coordination.

Scale indicators9 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Good Neighbor Pharmacy: AmerisourceBergen's independent pharmacy network program that aggregates thousands of independent community pharmacies and offers services including value-based program support, marketing, and clinical enablement — directly comparable to CPESN's network aggregation and clinical service positioning.
• Aspen RxHealth: Marketplace platform that connects independent pharmacists to clinical opportunities with health plans, enabling them to deliver medication management, adherence, and other reimbursable services — comparable to CPESN's core function of routing community pharmacists into payer value-based programs.
• OutcomesMTM: Cardinal Health-owned service that contracts with health plans to deliver medication therapy management services through a national network of local pharmacists — directly comparable to CPESN's payer-mediated clinical service model and use of independent pharmacy points of care.
• PBA Health: Pharmacy services organization supporting independent pharmacies with payer contracting, group purchasing, and clinical program enablement — comparable as a service wrapper around independent pharmacies seeking VBC participation.
• Arete Pharmacy Network: PSAO and independent pharmacy network contracting with payers and PBMs on behalf of member pharmacies — comparable as an independent-pharmacy aggregation and contracting layer.
• Atlas Health: Value-based pharmacy services company that partners with health plans to deploy pharmacist-led clinical interventions through pharmacy networks — directly comparable to CPESN's value-based contracting and clinical intervention model.
• EPIC Pharmacies Network: Pharmacy services administrative organization (PSAO) that contracts on behalf of independent community pharmacies with payer networks and PBMs — comparable as an aggregator enabling independents to participate in clinical and value-based programs.

Emerging players

• Clarest Health: Pharmacy services platform focused on clinical service enablement, medication management, and value-based care support — comparable as a partial-overlap emerging player in pharmacy-enabled VBC delivery.

Broad incumbents

• Walgreens Boots Alliance: Large retail pharmacy chain with VillageMD primary care and clinical service capabilities that competes for the same payer value-based contracts — comparable as a broader community pharmacy footprint, but operating at scale rather than as an independent-pharmacy aggregator.
• CVS Health: Integrated retail pharmacy, PBM (Caremark), and health plan (Aetna) operator with substantial community pharmacy footprint and value-based care programs — comparable as a broad incumbent in pharmacy-enabled value-based care delivery.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/CPESN
• Facebookfacebook.com/CPESN
• LinkedInlinkedin.com/company/cpesn
• Instagraminstagram.com/cpesn?igshid=YmMyMTA2M2Y=

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 records

Subsidiaries14 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 CPESN