Who runs the pharmacy benefit, and whether they say so themselves.
Every PBM that appears on a health plan's Form 5500 Schedule C, sorted the way Calliope sorts them: by who owns the PBM, where the claims actually adjudicate, and whether the pricing model the company markets is the one its structure supports. "Transparent" has stopped being a differentiating word. All three of the largest PBMs now use it. This page is how we tell the label from the structure.
Size puts a PBM in a tier. Structure decides what the tier means.
Tier is about scale and ownership. Pricing model is a separate axis, and a small PBM can be pass-through while a large one is not. The counts below are health-plan filings that name the PBM on Schedule C.
CVS Caremark, Express Scripts, Optum Rx. Insurer-owned, vertically integrated with retail, mail and specialty pharmacy, each with an offshore rebate purchasing group.
792 filings in 2024 · down from 892 in 2020
National PBMs outside the Big Three, mostly insurer-owned. The tier that consolidated: since 2022 two of its names were sold and a third renamed.
133 filings in 2024 · down from 234
Smaller independents and plan-affiliated PBMs. Several are pass-through by contract but sit here on size.
69 filings in 2024 · from 71
Independent, non-integrated PBMs whose default contract is pass-through: no spread, rebates returned, flat administrative fee. Two names in the tier sign that contract but still adjudicate on a Big Three PBM, and they are marked.
317 filings in 2024 · up from 219
Forty-four names. What each one is, who owns it, and what its own site says.
"Reads as" is our structural read, not the company's. It answers one question: when a plan sponsor signs with this name, who actually processes the claim and on what terms.
| PBM | Ownership and integration | Reads as | 2020 | 2024 | What the company says |
|---|---|---|---|---|---|
| Big Three all three now market a transparent or rebate-free model | |||||
| Express ScriptsEvernorth, The Cigna Group | Cigna-owned. Accredo specialty and Express Scripts mail. Ascent purchasing group. | Integrated, transparent option | 360 | 367 | ClearCareRx option: clients pay exactly what Express Scripts pays. A rebate-free model announced October 2025 becomes the standard for all clients in 2028. |
| Optum RxUnitedHealth Group | UnitedHealth-owned. Optum Specialty, mail and infusion pharmacy. Emisar purchasing group. | Integrated, marketed transparent | 359 | 250 | Positions itself as the first comprehensive, transparent PBM; 100% rebate pass-through pledged by January 2028; flat-fee model announced May 2026. |
| CVS CaremarkCVS Health | CVS-owned. CVS retail, specialty and mail. Aetna is a sister company. Zinc purchasing group. | Integrated, transparent option | 185 | 194 | 99% of rebates go directly back to you. TrueCost acquisition-based pricing, optional and phased in. |
| Mid tier consolidation, not defection | |||||
| Prime Therapeutics19 Blue Cross Blue Shield plans | Insurer consortium. Absorbed Magellan Rx in December 2022; unified brand September 2024. | Integrated | 48 | 45 | Truly transparent and conflict free. No pass-through, no-spread or rebate claim. |
| CarelonRxElevance Health · was IngenioRx until 2023 | Elevance-owned. CarelonRx mail and specialty, BioPlus. | Integrated | 113 | 46 | No transparency claim. Not tied to traditional PBM modelsis the closest language. |
| MedImpactindependent, privately held | Largest independent PBM. Acquired Elixir from Rite Aid in February 2024, including its mail and specialty pharmacies. | Pass-through option, own claims | 11 | 15 | OnePrice model: 100% Pass-Throughwith fixed administrative fees. Offered as a named model alongside others. |
| Elixirlegacy · now MedImpact | Was Rite Aid's PBM. Sold in the Rite Aid bankruptcy; brand retired July 2024. | Retired brand | 39 | 21 | Legacy site reads Elixir is now MedImpact. |
| Scrip WorldMeritain Pharmacy Solutions · Aetna, CVS Health | Aetna's TPA pharmacy arm. Contracts as Scrip World, LLC; CVS Caremark processes the claims. | Carrier contract, Caremark claims | 2 | 1 | Market-leading pricing through our relationship with CVS Health. |
| Magellan Rxlegacy · now Prime | Was Centene's. Sold to Prime for $1.35B; renamed Prime Therapeutics Management October 2024. | Retired brand | 21 | 6 | Brand retired. Inherits Prime's positioning. |
| Regional pricing model is a separate axis from size | |||||
| Benecard PBFBenecard Holdings | Private. Affiliated BeneCard Central Fill mail pharmacy. | Pass-through, own claims | 20 | 16 | No rebates, no spread games. Calls itself a Prescription Benefit Facilitator rather than a PBM. |
| Maxornow VytlOne · private equity | Beecken Petty O'Keefe. Owns mail and specialty pharmacies. Rebranded VytlOne June 2025. | Pass-through offered, not default | 7 | 15 | Culture of transparency. Pass-through described as an available arrangement. |
| WellDyneThe Carlyle Group | Private-equity owned since 2017. WellDyneRx mail and specialty in Lakeland, Florida. | Pass-through offered, not default | 15 | 8 | WellDyne Clear option: true costs and full rebate passthrough. |
| Script Carefamily-owned, Beaumont, Texas | Independent since 1989. Uses Drug Source as its mail pharmacy. | Traditional | 6 | 3 | No transparency claim. No smoke and mirrorsis the closest. |
| AbarcaAbarca Health | Independent, no owned pharmacies. Combining with LucyRx under a new parent, expected Q3 2026. | Pass-through, own claims | 0 | 0 | Payers are only charged the amount we remit to the pharmacy. |
| ProCare RxMC-Rx is the operating brand | Private. Owns a mail and specialty pharmacy. ProCare Rx is the claims and technology arm; MC-Rx is the PBM. | Pass-through, own claims | 1 | 2 | No hidden fees, no spread pricing; auditable, transparent, pass-through model. |
| ProActKPH Healthcare Services · Kinney Drugs | Employee-owned. ProAct Pharmacy Services mail order and Noble Health specialty pharmacy. | Pass-through offered, not default | 5 | 9 | Employee-owned PBM offering pass-through and traditional contracts. |
| Global Pharmaceutical BenefitsNew Jersey | Full-service PBM for union health funds and public employers in New Jersey and Pennsylvania. | Traditional | 4 | 4 | Pharmacy network of 60,000 and a mail service; no pricing-model claim. |
| RxResultsLittle Rock, Arkansas | Clinical and reference-based-pricing overlay that sits on top of a sponsor's PBM. | Not a PBM | 11 | 9 | Describes itself as a Pharmacy Risk Manager that doesn't replace a PBM. |
| ArmsRxconsulting firm | PBM contract negotiation, audits and RFP management. | Not a PBM | 0 | 3 | Self-described independent PBM consulting firm. |
| PerformRxAmeriHealth Caritas · closing | Owned by Independence Health Group and BCBS Michigan. Shutting down December 31, 2026; book moves to Optum Rx. | Integrated | 0 | 0 | A Full Transparencyline on the home page; no pricing-model claim. |
| Envolve PharmacyCentene · legacy | Wound down at the end of 2023 after Medicaid spread-pricing settlements. Express Scripts took the book. | Retired brand | 2 | 0 | No PBM pages remain on the site. |
| Catalyst Rxlegacy · inside Optum Rx since 2015 | Became Catamaran in 2012; Catamaran was absorbed by Optum Rx in 2015. | Retired brand | 0 | 0 | No live site. |
| Transparent two names sign transparent contracts but adjudicate on a Big Three PBM | |||||
| RxBenefitsprivate equity · Advent, Great Hill | Pharmacy benefits optimizer. Its marketplace gives clients access to the three largest PBMs’ contracts on a flat fee; the claim adjudicates at that PBM. Launched an affiliate PBM, Illuminate Rx, in September 2025. | Transparent contract, Big Three claims | 74 | 76 | Paid directly by our clients via a flat administrative fee; no spread, no rebate withholds. |
| Sav-Rxfamily-owned, Fremont, Nebraska | Independent since 1968. Owns its mail-order facility. Adjudicates its own claims. | Pass-through, own claims | 44 | 71 | Its program is radically transparent: 100% of every dollar we collect from any drug manufacturer, not just rebates, is passed on to your plan; NADAC pricing; a flat administrative fee. |
| EmpiRx Healthprivate equity · Nautic Partners | No pharmacies. Value-based, pay-for-performance model. | Pass-through, own claims | 14 | 30 | Leads with clinical pay-for-performance and a savings guarantee rather than a pricing-model claim. |
| NavitusSSM Health and Costco | Co-owned by a health system and a pharmacy chain. Owns Lumicera specialty pharmacy. | Pass-through, own claims | 33 | 24 | 100% Pass-through Model; 100% Financial and Operational Transparency. |
| Judi RxJudi Health · was Capital Rx until July 2026 | Venture-backed. No pharmacies. | Pass-through, own claims | 3 | 19 | Pass-through pharmacy benefit administration; No hidden admin costs or rebate fees. |
| Livinitiwas Southern Scripts until 2023 | Private-equity majority (Water Street). No pharmacies. | Pass-through, own claims | 11 | 15 | 100% of rebates and discounts are passed back to the employer. |
| SmithRxSmith Health | Venture-backed. No pharmacies. | Pass-through, own claims | 9 | 15 | Universal pass-through pricing, the same price for all with no spread. |
| Rightwayventure-backed | Navigation company with a PBM line. States no vertical integration. | Pass-through, own claims | 3 | 10 | 100% pass-through model; No spread pricing. No hidden revenue. No rebate games. |
| True Rxfamily-owned, Washington, Indiana | Independent, pharmacist-led. No pharmacies. Files as True Rx Management Services and True Rx Health Strategists. | Pass-through, own claims | 5 | 22 | Transparent, pharmacist-led; 100% pass-through. |
| DrexiAMPS | Subsidiary of Advanced Medical Pricing Solutions. No owned or affiliated pharmacy; Cost Plus Drugs partner. | Pass-through, own claims | 0 | 9 | Pass-thru pricingon a 65,000-pharmacy network; does not steer patients. |
| Citizens RxChicago | Independent. Serves health plans and employer groups in the US and Puerto Rico. | Pass-through, own claims | 2 | 4 | Full-service PBM with transparent pass-through positioning. |
| TrueScriptsWashington, Indiana | Pharmacist-founded in 2014. A separate company from True Rx in the same town. | Pass-through, own claims | 5 | 4 | Transparent PBM; pass-through pricing. |
| US-Rx CareRight Rx LLC · Florida | Independent since 2007. Its Right Rx program can overlay another PBM. | Pass-through, own claims | 2 | 3 | 100% pass-throughunder a legally binding ERISA fiduciary standard. |
| ApproRxWaynesville, Ohio | Independent. Owns no pharmacies, mail order or specialty. | Pass-through, own claims | 0 | 0 | Transparent, fiduciary-mindset PBM; a PMPM cap reconciled dollar for dollar. |
| Tria Healtha Stellus Rx company since April 2026 | Pharmacist-led chronic-condition management. Appears on Schedule C as a pharmacy vendor. | Not a PBM | 11 | 13 | No pricing-model claim. |
| National CooperativeRxmember-owned cooperative | Purchasing coalition, about 575,000 lives. Its single PBM partner has been CVS Caremark; MedImpact was added as a pass-through option in July 2026. | Transparent contract, Caremark claims | 5 | 6 | Transparent Pricingand 100% claims audit. |
| Specialty and adjacent pharmacy vendors that are not a plan's PBM; outside the tier counts | |||||
| PrudentRxspecialty copay program | Specialty copay-maximizer program administered alongside the plan's PBM, chiefly CVS Caremark. | Not a PBM | 4 | 15 | No pricing-model claim. |
| Rx Savings SolutionsMcKesson | Member-facing prescription savings navigation that layers on the existing PBM. | Not a PBM | 7 | 10 | No pricing-model claim. |
| VIVIO Healthpublic benefit corporation | Specialty-drug carve-out. Becomes the primary payer for the plan's specialty list; owns no pharmacies. | Specialty carve-out, flat fee | 1 | 2 | Flat PMPM feeis its only source of revenue; open-market pricing. |
| ElmcRx SolutionsELMC Risk Solutions | Pharmacy risk management and specialty cost containment for self-funded plans. | Not a PBM | 2 | 4 | Describes itself as a pharmacy risk manager. |
Counts are health-plan Form 5500 filings naming the PBM on Schedule C, one per PBM per filing, on the September 2026 filing batch. Pension-plan filings that name a PBM (retiree drug programs run through the pension trust) are excluded. Caremark filed under the CVS Pharmacy or CVS Health name is counted as Caremark. Humana Pharmacy Solutions and Cigna Pharmacy are in the directory with no matched filings and are omitted here. Company quotations are from each company's own website or press releases as of September 2026.
The label moved. The structure didn't.
Four things worth knowing
- "Transparent" is no longer a differentiator. Optum Rx calls itself the first comprehensive transparent PBM. Express Scripts goes rebate-free by default in 2028. Caremark advertises 99% rebate return. Each still owns the pharmacies it steers to and the purchasing group that negotiates its rebates. The word tells you less than the ownership chart.
- Some transparent contracts still run on Big Three rails. RxBenefits and National CooperativeRx sign flat-fee, no-spread contracts on the sponsor's behalf, and the claim is then adjudicated by Express Scripts, Optum Rx or Caremark. The contract is transparent. The chassis is not.
- The Big Three decline is mostly Optum's. Express Scripts and Caremark held flat or grew between 2020 and 2024. Optum Rx lost 109 health-plan filings, most of them plans that stopped reporting drug claims as PBM compensation while staying on a UnitedHealthcare-administered plan.
- The mid tier was bought, not abandoned. Magellan Rx went to Prime, Elixir to MedImpact, IngenioRx became CarelonRx. The Big Three's share of the pool held flat because consolidation moved names, not sponsors.
Where the growth is
Health-plan filings naming the PBM on Schedule C, 2020 to 2024.
| Cohort | 2020 | 2024 | Change |
|---|---|---|---|
| Pass-through PBMs that adjudicate their own claims Judi Rx, EmpiRx, Navitus, Liviniti, SmithRx, Rightway, Sav-Rx | 117 | 184 | +57% |
| Transparent contracts on a Big Three chassis RxBenefits, National CooperativeRx | 79 | 82 | +4% |
| Independent pass-through PBMs added to the directory in September 2026 True Rx, TrueScripts, Citizens Rx, US-Rx Care, ApproRx, Drexi | 14 | 42 | +200% |
| Big Three | 904 | 811 | −10% |
The growth is in PBMs that process their own claims. The transparent-contract book that still rides the Big Three was flat. Transparent PBMs were 15% of filings that name a PBM in 2020 and 23% in 2024.
Three questions for any PBM line on a Schedule C.
An insurer, a pharmacy chain, a private-equity fund, or nobody. Ownership predicts where the plan's spend is steered more reliably than any pricing claim.
The name on the contract and the name on the claim can differ. If the answer is a Big Three PBM, the rebate is negotiated by that PBM's purchasing group, whatever the contract says about pass-through.
Most large PBMs now offer a transparent model. Few make it the standard. Ask which contract this plan is on, and since when.
Above-benchmark compensation or an integrated ownership structure is not evidence of wrongdoing. Use the directory to focus a documented review and to decide what to ask for at renewal.
Prepared from CalliopeFlow on Form 5500 Schedule C filings for health plans, filing years 2020 through 2024 as posted in the September 2026 filing batch, and from company websites and press releases checked September 2026. Tier and pricing-model assignments are Calliope's and are revisited as companies change ownership, rename, or change their default contract. Filing counts are one per PBM per filing and reflect the plans that disclosed a PBM on Schedule C, which is a subset of the market.