Pharmacy Benefit Management
PBM Solutions is a pharmacist-led pharmacy benefit management consultancy offering 340B program administration, formulary optimization, claims utilization management, and PBM contract negotiation. Founded by a PharmD in 2016, it serves tribal health systems, FQHCs, hospitals, self-insured employers, and government entities.
- Company typePrivate
- Founded2016
- HeadquartersRockville, United States
- Headcount11–50
- GTM typeB2B
- OfferingServices
What Pharmacy Benefit Management does
PBM Solutions is a pharmacist-led pharmacy benefit management consultancy headquartered in Baton Rouge, Louisiana, founded in 2016. The firm delivers outsourced PBM consulting and managed services including 340B program administration (third-party administration, HRSA compliance, auditing, reporting), PBM contract review and procurement (RFP and negotiation support), pharmacy benefit plan design, formulary management, claims utilization management and medication utilization review, savings analysis, and onsite/near-site plus mail-order pharmacy services. The company is founded and led by a Doctor of Pharmacy (PharmD), positioning clinical expertise and first-hand operational experience against traditional PBMs. Core differentiators include transparent, fee-disclosed pricing, a "pharmacy-first" patient-centered approach rather than compliance-only or financial-first models, and a customized "Crawl/Walk/Run" implementation strategy.
The company targets seven customer segments: tribes and tribal health systems, federally qualified health centers (FQHCs), critical access hospitals (CAH), disproportionate share hospitals (DSH), self-insured and level-funded employers, government entities and union funds, and third-party administrators (TPAs). Customer outcomes cited include 20-30% reduction in pharmacy plan costs, up to 60% additional savings via 340B and onsite pharmacy programs, average client savings of 25%, and potential of 50%+ when fully optimized. Named customer references (Absentee Tribal Health System) and patient-level testimonials support the savings narrative but do not constitute enterprise client disclosure.
PBM Solutions operates a direct sales model combining enterprise field sales for larger healthcare organizations (hospitals, tribal health systems, government entities) with inside sales and phone/contact-based consultation for mid-market employers, TPAs, and smaller healthcare organizations. Pricing is customized, quote-based, and structured around multi-year managed services contracts. The company does not publicly disclose revenue, funding, or detailed pricing; it was recognized among Louisiana State University's 100 fastest-growing tiger businesses in 2024, signaling scale and momentum, though absolute revenue remains undisclosed.
Pharmacy Benefit Management firmographics
Firmographics- Name
- Pharmacy Benefit Management
- Legal name
- PBM Solutions
- Website
- https://pbm-solutions.com
- Company type
- Private
- Founded year
- 2016
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- PBM Solutions is a pharmacist-led pharmacy benefit management consultancy offering 340B program administration, formulary optimization, claims utilization management, and PBM contract negotiation. Founded by a PharmD in 2016, it serves tribal health systems, FQHCs, hospitals, self-insured employers, and government entities.
- Ownership category
- akta.pro rank
Pharmacy Benefit Management industry classification
Industry- Product category
- Pharmacy Benefit Management Services
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Management Consulting Services (54161)
- SIC
- Services-Management Consulting Services (8742)
- akta.pro primary industry
- Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)
- akta.pro secondary industries
- Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Prior Authorization, Utilization Management & Step Therapy (HLAEAKAG), Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI)
Keywords
Where Pharmacy Benefit Management is headquartered
LocationHeadquarters
- HQ city
- Rockville
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Pharmacy Benefit Management business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Pharmacy Benefit Management Consulting Services: Ongoing pharmacy benefit optimization services including contract reviews, plan design, claims management, and 340B program administration. Revenue is generated through managed service engagements with healthcare organizations seeking cost reduction on pharmacy benefits. The model involves customized strategic consulting with measurable savings outcomes.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Multi-year contract | Customized consulting and management services with quote-based pricing |
Go-to-market motion1 record
Distribution channels2 records
Marketing channels4 records
Pharmacy Benefit Management product offering
Product offeringCore offering
PBM Solutions delivers pharmacy benefit management consulting and management services to healthcare organizations, including 340B program administration, formulary optimization, claims utilization review, contract negotiation, and customized plan design. The firm helps clients reduce pharmacy spend via transparent, data-driven strategies and provides ongoing managed-service engagements rather than acting as a traditional PBM that processes claims through its own network.
Product overview
PBM Solutions offers a unified pharmacy benefit management platform with multiple integrated service modules. The core platform provides transparent pricing, flexible plan design, and robust reporting, supported by specialized modules including 340B Program Management (with third-party administration, reporting, auditing, and HRSA compliance), Contract Review and PBM Procurement, Pharmacy Benefit Plan Design, Formulary Management, Claims Utilization Management, Pharmacy Operations Services, Onsite/Near Site Pharmacy Services, and Savings Analysis. The platform is designed for tribal health systems, FQHCs, rural healthcare organizations, self-insured employers, government entities, and third-party administrators.
Differentiator
Problem solved
Functional benefit
Products and services
- PBM Solutions Core Platform Unified pharmacy benefit management offering providing transparent pricing, flexible plan design, and robust reporting for healthcare organizations seeking cost optimization and 340B program management.
- 340B Program Management Comprehensive 340B program optimization service covering third-party administration, reporting, auditing, and HRSA compliance for tribal health systems, FQHCs, and rural healthcare organizations.
- Contract Review and PBM Procurement RFP and contract negotiation service that provides objective comparisons of incoming vendor proposals, evaluating client service, plan design, clinical programs, and pricing on behalf of healthcare organizations.
- Pharmacy Benefit Plan Design Customized pharmacy benefit plan development service offering innovative cost containment solutions built on comprehensive analysis, including 340B program design and third-party administration.
- Formulary Management Formulary oversight service providing expert recommendations on additions and deletions based on market conditions to maximize cost efficiency while ensuring effective medication provision.
- Claims Utilization Management Claims auditing and utilization tracking service including claim history auditing, copay card programs, and year-round utilization monitoring to optimize pharmacy benefit spending.
- Pharmacy Operations Services Day-to-day pharmacy management consultation covering clinical authorizations, prior authorization design, disease management, and onsite medical clinic optimization.
- Onsite and Near Site Pharmacy Services Design, development, and management of onsite and near site pharmacy services for large group employers, including mail order pharmacy options, intended to drive additional pharmacy cost savings.
- Savings Analysis Comprehensive analysis of a client's current prescription benefit plans to identify cost reduction opportunities and quantify potential savings achievable through service optimization.
Quantifiable outcome
- 20-30% reduction in pharmacy plan costs
- +3 more outcomes
Companies that use Pharmacy Benefit Management
Customer profileNamed customers3 records
Segments7 records
Ideal customer profiles5 records
Pharmacy Benefit Management technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature5 records
Pharmacy Benefit Management partnerships and signals
Strategic signalScale indicators3 records
Recent moves3 records
Expansion highlights5 records
Pharmacy Benefit Management competitors and assessment
Company assessmentDirect peers
- AffirmedRx: AffirmedRx is a transparent PBM serving safety-net providers and health systems, with 340B and Medicaid expertise. It directly overlaps PBM Solutions' 340B and FQHC/tribal focus.
- Capital Rx: Capital Rx operates a transparent, technology-driven PBM platform (JUDI) serving employers, unions, and TPAs. Its model of unified claims processing and aligned pricing mirrors PBM Solutions' transparency-first positioning.
- Navitus Health Solutions: Navitus is a transparent PBM serving health plans, employers, and government programs with full pass-through pricing. Its emphasis on transparency and clinical programs is highly comparable to PBM Solutions' value proposition.
- RxBenefits: RxBenefits provides PBM procurement, contracting, and optimization services for self-insured employers and benefit brokers. It is directly comparable to PBM Solutions' consulting-led model focused on transparent PBM contracting and cost reduction.
- WellDyne: WellDyne is a transparent PBM focused on self-insured employers, with pass-through pricing and clinical management. It competes in the same employer PBM optimization space as PBM Solutions.
- SmithRx: SmithRx is a transparent PBM built for self-insured employers, combining technology-driven claims administration with concierge service. It competes with PBM Solutions on transparent pricing and employer-focused PBM optimization.
- EmpiRx Health: EmpiRx Health is a clinically-driven, transparent PBM serving self-insured employers and health plans. It shares PBM Solutions' pharmacist-led, value-based approach to formulary and utilization management.
Broad incumbents
- OptumRx (UnitedHealth Group): OptumRx is one of the three largest U.S. PBMs, offering integrated pharmacy, care delivery, and data analytics. It represents the scale incumbent benchmark that PBM Solutions differentiates against via transparency.
- Express Scripts (Cigna): Express Scripts is a top-three U.S. PBM serving employers, health plans, and government clients. As a broad incumbent, it sets the procurement and rebate standard PBM Solutions competes against in employer and health system RFPs.
- CVS Health (Caremark): CVS Caremark is the largest U.S. PBM, serving national employers, health plans, and government programs. It is a broad incumbent that PBM Solutions positions against on transparency, pricing, and customer alignment.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat3 records
Key risks6 records
Key highlights6 records
Customer concentration
Pharmacy Benefit Management social profiles
Digital presencePharmacy Benefit Management financial estimates
Financial estimateRevenue estimate
Valuation estimate
Pharmacy Benefit Management leadership team
Management profileNumber of profiles
Profiles1 record
Pharmacy Benefit Management funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Pharmacy Benefit Management M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Pharmacy Benefit Management
What does Pharmacy Benefit Management do?
PBM Solutions delivers pharmacy benefit management consulting and management services to healthcare organizations, including 340B program administration, formulary optimization, claims utilization review, contract negotiation, and customized plan design. The firm helps clients reduce pharmacy spend via transparent, data-driven strategies and provides ongoing managed-service engagements rather than acting as a traditional PBM that processes claims through its own network.
Is Pharmacy Benefit Management a public or private company?
Pharmacy Benefit Management is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Pharmacy Benefit Management founded?
Pharmacy Benefit Management was founded in 2016. It employs 11 to 50 people.
Where is Pharmacy Benefit Management based?
Pharmacy Benefit Management is headquartered in Rockville, United States, in the North America region.
How does Pharmacy Benefit Management make money?
One revenue line is on record: pharmacy Benefit Management Consulting Services.
Who are Pharmacy Benefit Management's main competitors?
Direct peers on record are AffirmedRx, Capital Rx, Navitus Health Solutions, RxBenefits, WellDyne, SmithRx and EmpiRx Health. Broad incumbents are OptumRx (UnitedHealth Group), Express Scripts (Cigna) and CVS Health (Caremark).
Does Pharmacy Benefit Management have an API?
No public API is recorded for Pharmacy Benefit Management.
What industry is Pharmacy Benefit Management in?
Pharmacy Benefit Management's product category is Pharmacy Benefit Management Services. Its primary akta.pro industry code is HLAEAKAK, Pharmacy Benefit Analytics, Reporting & Employer Consulting, with a secondary code of HLAEAKAA, Formulary Management & Clinical Pharmacy Programs. Its NAICS code is 524292 and its SIC code is 8742.