Exemplar

What Exemplar does

Exemplar Healthcare Partnership Organization is a private, for-profit healthcare partnership network founded in 2019 and headquartered in High Point, North Carolina. The company builds and operates a member-owned network that aggregates independent pharmacies, independent primary care physicians, and healthcare service providers under a cooperative structure in which members hold equal voice and receive equal payment distribution. Its purpose is to enable independents to collectively compete with national pharmacy and primary care chains through preferred provider status, improved reimbursement rates, and access to a suite of managed services.

The company's core product is the Exemplar Healthcare Partnership Network, supported by a web-based platform that includes a Network Pharmacy Finder (ZIP-code-based search with configurable radius) and integrations with claims processing platforms for PBM services. Around this core, Exemplar bundles five service modules: Sourcing (access to VAWD-certified wholesale distributors across 48 states), Insurance Solutions (Medicare Advantage, individual/group health, life, P&C), Pharmacy Benefit Management (via partner Pro Rx Solutions), Pharmacy Management (KPI monitoring, inventory, operations), and Physicians Clinical Management Services (credentialing, contracting, billing optimization, accreditation). Additionally, Exemplar operates Exemplar Health, a CMS-approved Medicare Pharmacy Drug Plan serving beneficiaries in North Carolina and Texas, structured to eliminate DIR fee clawbacks.

Exemplar's business model combines zero-cost network membership with transaction-based revenue streams. The PBM is contractually required to distribute 50% of net profit to the network, creating a recurring revenue stream tied to prescription volume across member pharmacies. Additional revenue derives from insurance plan administration (PDP and commercial plans) and indirect monetization through preferred partner referral economics. Go-to-market combines direct field sales to independents, channel partnerships with service providers, and CMS-approved Medicare distribution. The company self-describes as the largest independent healthcare network in the nation, though most data points originate from 2019–2021 and the scale of more recent member growth is not independently confirmed.

Name

Exemplar

Legal name

Exemplar Healthcare Partnership Organization

Website

https://exemplarhpo.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

101–250 employees

Short description

Exemplar Healthcare Partnership Organization is a member-owned network connecting independent pharmacies, primary care physicians, and service providers across 48 states, offering sourcing, PBM, insurance, and management services plus its own CMS-approved Medicare PDP.

Ownership category

akta.pro rank

Product category

Healthcare Partnership Network & Pharmacy Benefit Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Direct Health and Medical Insurance Carriers (524114), Agencies, Brokerages, and Other Insurance Related Activities (5242), Offices of Physicians (62111), Pharmacies and Drug Retailers (456110)

SIC

Insurance Agents, Brokers & Service (6411), Retail-Drug Stores And Proprietary Stores (5912), Services-Offices & Clinics Of Doctors Of Medicine (8011), Services-Computer Integrated Systems Design (7373)

akta.pro primary industry

Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN)

akta.pro secondary industries

Association & PEO Group Health Plans (AHP/PEO-Sponsored) (FSAIAFAH), Virtual Pharmacy & Medication Management Integration Platforms (HLALABAL)

Keywords

• Healthcare partnership network
• Pharmacy benefit management
• Independent pharmacy services
• Primary care management
• Medicare pharmacy drug plan

Headquarters

HQ city

High Point

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. PBM Revenue Share: The network generates revenue from the Pharmacy Benefit Management (PBM) operations. The PBM is required to pay 50% of Net Profit to the Network, creating a recurring revenue stream tied to prescription volume and pharmacy transactions within the network.
2. Network Membership Value: The network grows and becomes stronger as more independent pharmacies and physicians join, enabling Exemplar to earn more revenue in unison with its members. No membership fee is charged to join the network.
3. Insurance Plan Administration: Revenue generated from CMS-approved Exemplar Health PDP and commercial insurance plans, providing Medicare beneficiaries with coverage through independent pharmacies in North Carolina and Texas.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels7 records

Core offering

Exemplar operates a healthcare partnership network that unites independent pharmacies, primary care physicians, and service providers. The company delivers integrated service modules spanning VAWD-certified sourcing, insurance solutions, pharmacy benefit management, pharmacy management, and physicians clinical management, plus a CMS-approved Medicare Pharmacy Drug Plan (Exemplar Health PDP) serving North Carolina and Texas.

Product overview

Exemplar is a Healthcare Partnership Organization offering a unified platform of interconnected services for independent healthcare providers. The core product is the Exemplar Healthcare Partnership Network, which serves as the central hub connecting independent pharmacies and primary care physicians. Around this core, Exemplar provides five integrated service modules: Sourcing Services (VAWD-certified wholesale distribution), Insurance Solutions (Medicare Advantage, health, life, P&C), Pharmacy Benefit Management (claims, formulary, network), Pharmacy Management (operations, inventory, KPIs), and Physicians Clinical Management Services (credentialing, billing, accreditation). Additionally, Exemplar operates its own Medicare Pharmacy Drug Plan (Exemplar Health PDP). The network is powered by innovative software providing nationwide data access to independent healthcare providers.

Differentiator

Problem solved

Functional benefit

Products and services

• Exemplar Healthcare Partnership Network A collaborative healthcare network uniting independent pharmacies, primary care physicians, and service providers to compete with major healthcare organizations through shared tools, services, and expertise.
• Sourcing Services

Quantifiable outcome

• Nearly 250 network members within first six months
• +2 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

17 partnerships are on record, tiered preferred and core.

• NCPA (National Community Pharmacists Association)preferredStrategic or Co-development Partner · 30 July 2019Exemplar is a corporate sponsor of NCPA, participating in industry conferences and events to connect with independent pharmacists.
• IPD (IPD Pharma)coreStrategic or Co-development Partner · 1 May 2019IPD Pharma serves as a sourcing partner, providing independent VAWD certified wholesale distributors nationwide. The partnership offers low-cost, high-quality pharmaceutical products from over 65 manufacturers.
• Pro Rx SolutionscoreStrategic or Co-development Partner · 1 May 2019Pro Rx Solutions is an independent Pharmacy Benefit Manager (PBM) that tailors solutions to unique needs, reduces costs, and ensures customers get medicines at affordable prices. They are fully integrated with mail, specialty, and compounding pharmacies.
• Exemplar Insurance AssociatescoreChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance solutions partner providing marketing force for Exemplar Health and Exemplar Commercial Insurance. Offers Medicare Advantage, Medicare Support, and various individual and group insurance products.
• Exemplar HBA (Health Benefits Administrator)coreStrategic or Co-development Partner · 1 May 2019Exemplar Health Benefits Administrator serves as the engine that drives Exemplar Health, handling insurance administration and plan management.
• Elite Benefits GrouppreferredChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance solutions partner offering customized health insurance plans. Located in North Carolina, providing Individual Health, Group Health, Medicare Support, and other insurance products.
• Bukaty CompaniespreferredChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance solutions partner providing comprehensive insurance offerings including Individual Health, Group Health, Medicare Advantage, Life Insurance, and Commercial P&C.
• Precision Senior MarketingpreferredChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance partner focused on senior marketing and Medicare-related insurance products.
• Broker SourcepreferredChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance broker partner providing access to various insurance products and carrier relationships.
• Allstate BenefitspreferredChannel Partner/ Reseller/ Distributor · 1 May 2019National insurance provider partner offering employee benefits and individual insurance products.
• Pinnacle InsurancepreferredChannel Partner/ Reseller/ Distributor · 1 May 2019Insurance solutions partner providing commercial and personal insurance products.
• Pharmacy Management Company (pharman.co.uk)preferredImplementation/ SI/ Consulting Partner · 1 May 2019Pharmacy management services partner helping independent pharmacies implement cost-saving strategies and operational improvements.
• Pharmacy Management (pharmacymanagement.net)preferredImplementation/ SI/ Consulting Partner · 1 May 2019Management services partner providing pharmacy management expertise and operational support.
• The Pinnacle Financial GrouppreferredImplementation/ SI/ Consulting Partner · 1 May 2019Pharmacy management partner offering financial expertise and business optimization services for independent pharmacies.
• SRG (SpecRx Group)preferredImplementation/ SI/ Consulting Partner · 1 May 2019Pharmacy management services partner providing operational support and management solutions for independent pharmacies.
• Exemplar PAP (Physicians Administration Partner)preferredImplementation/ SI/ Consulting Partner · 1 May 2019Management services partner focused on supporting independent physician practices with administrative functions.
• CMS (Centers for Medicare & Medicaid Services)coreOthers · 1 May 2019CMS approved Exemplar Health PDP (Pharmacy Drug Plan) contracting documents and post-application requirements for 2021, authorizing service to Medicare beneficiaries in North Carolina and Texas.

Scale indicators5 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Pro Rx Solutions: Independent pharmacy benefit manager that is Exemplar's core PBM partner, providing claims processing, mail/specialty/compounding integration, and formulary management for the Exemplar network. Directly comparable in PBM service scope and independent-pharmacy focus.
• IPC (Independent Pharmacy Cooperative): Member-owned purchasing and service cooperative for independent pharmacies, providing sourcing, group purchasing, and operational support — a directly comparable independent-pharmacy alliance model to Exemplar's network.
• PBA Health: Independent pharmacy services organization offering group purchasing, PBM partnerships, insurance, and practice management to independent pharmacies. Highly comparable mission, customer base, and service portfolio to Exemplar.
• Apexus (340B Prime Vendor Program): PBM-like service provider focused on 340B drug pricing programs for safety-net providers, with contracting, distribution, and compliance infrastructure. Comparable as an alternative/non-traditional PBM serving specific provider segments.

Broad incumbents

• Cardinal Health (Cordavis / RxBenefits): Major pharmaceutical distributor and healthcare services company with significant exposure to independent pharmacy sourcing, distribution, and PBM-adjacent services. Comparable in distribution and back-office services for pharmacies but operates at vastly greater scale.
• Cencora (formerly AmerisourceBergen): Top-tier pharmaceutical distributor with independent pharmacy solutions, specialty distribution, and consulting services. Comparable in serving independent pharmacies with sourcing and operational services, though as a global incumbent.
• McKesson: One of the largest pharmaceutical distributors in the U.S. with retail, specialty, and independent pharmacy services including Health Mart, a franchise network for independents. Comparable in providing sourcing, technology, and clinical services to independents.
• CVS Health (Caremark / Aetna): Vertically integrated PBM (Caremark) and health insurer (Aetna) with the largest U.S. prescription volume share. The dominant incumbent competitor whose reimbursement policies and DIR fees Exemplar's PDP is explicitly designed to counter.
• Express Scripts (Cigna / Evernorth): One of the three largest U.S. PBMs, integrated with Cigna health insurance. A primary incumbent competitor shaping the reimbursement and DIR-fee economics that Exemplar's model is built to avoid.
• OptumRx (UnitedHealth Group): The third major vertically integrated PBM, part of UnitedHealth Group, and a key incumbent competitor whose scale and payer integration set the market standards for PBM pricing that Exemplar challenges.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/ExemplarHPO
• LinkedInlinkedin.com/company/exemplar-healthcare-partnership-organization

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 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 Exemplar