Mid-Market PBMs Rely on Differentiation for Success

Consolidation at the Top Means More Challenges for Mid-Size Companies like Prime Therapeutics and SXC Health Solutions in the Pharmacy Benefit Manager Market, According to HealthLeaders-InterStudy

NASHVILLE, Tenn.--(BUSINESS WIRE)-- HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that the potential merger of two of the top three pharmacy benefit management companies, Express Scripts and Medco, creates opportunities among the mid-tier PBMs to secure new contracts and differentiate themselves from larger competitors.

Companies like Prime Therapeutics and SXC Health Solutions are touting their differentiation to distinguish themselves from Medco, Express Scripts and CVS Caremark. The merger of Medco and Express Scripts could occur by mid-2012.

Prime, for example, has major Blue plans’ relationships, which offers it the unique ability to integrate medical and pharma analytics.

“Prime’s integration capabilities means their clients have a clearer picture of insured members’ health,” said HealthLeaders-InterStudy Senior Analyst Chris Lewis. “This allows Prime’s clients to identify and close gaps in care and reduce long-term costs.”

SXC’s advantages are built around its scalability, its reputation for technology solutions and its successful niche in managing Medicaid accounts.

“SXC is one of the hottest mid-market PBMs at the moment,” Lewis said. “They tend to be popular with more sophisticated plan sponsors who want to craft and customize their own programs, using the PBM’s technology support platforms.”

Complete PBM profiles of both companies, along with eight other key market players, are available from HealthLeaders-InterStudy as part of its Pharmacy Benefit Evaluator platform.

The PBM profiles will be updated throughout the year, capturing the latest developments among the profiled pharmacy benefit managers. In addition to key market events, the reports will also include competitive analysis, markets covered, and products and services offered by each company.

The Pharmacy Benefit Manager reports include the following companies:

  • Prime Therapeutics
  • SXC Health Solutions/informedRx
  • Catalyst Health Solutions
  • CVS Caremark
  • OptumRx
  • Navitus Health Solutions
  • MedImpact HealthCare Systems
  • Express Scripts
  • PerformRx
  • Medco

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources Group company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources Group

Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at www.DecisionResourcesgroup.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.


Kristi Guillemette, 781-993-2618
[email protected]
Decision Resources Group
Elizabeth Marshall, 781-993-2563
[email protected]

KEYWORDS:   United States  North America  Tennessee

INDUSTRY KEYWORDS:   Health  Pharmaceutical  Professional Services  Insurance  General Health  Managed Care