Pharmacy Benefit Management

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.

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

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

• Pharmacy benefit management
• 340B program optimization
• Pharmacy benefit consulting
• Formulary management services
• Claims utilization management

Headquarters

HQ city

Baton Rouge

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. 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

Go-to-market motion1 record

Distribution channels2 records

Marketing channels4 records

Core 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

Named customers3 records

Segments7 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Scale indicators3 records

Recent moves3 records

Expansion highlights5 records

Direct 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

• LinkedInlinkedin.com/company/pbm-solutions

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

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 Pharmacy Benefit Management