Is GoodRx a pharmacy benefit manager?
Asked by: Kamille Keebler | Last update: December 5, 2025Score: 4.9/5 (63 votes)
Does GoodRx have a PBM?
GoodRx doesn't negotiate its prices with pharmacies; it uses PBMs for that. So how does GoodRx make money? By getting a cut of the price PBMs negotiate for them, similar to how PBMs make money, explained Reshma Ramachandran, an assistant professor at the Yale School of Medicine.
What is an example of a pharmacy benefit manager?
Currently the three largest PBMs - CVS Caremark, Express Scripts and OptumRx (a division of United Healthcare) hold nearly 80% of the prescription benefits market in the U.S.
Who are the big 3 pharmacy benefit managers?
Regarding the 3 major pharmacy benefit managers (PBMs) significantly controlling the US drug supply chain—CVS Caremark, Express Scripts, and Optum Rx—their concentration varied noticeably amongst commercial insurance, Medicare Part D, and Medicaid managed care markets.
What type of company is GoodRx?
GoodRx Holdings, Inc., is an American healthcare company that operates a telemedicine platform and free-to-use website and mobile app that track prescription drug prices in the United States and provide drug coupons for discounts on medications.
How pharmacy benefit managers influence drug pricing
Is GoodRx a benefit provider?
No. GoodRx is not a type of health plan or insurance. GoodRx is a service that helps Americans find lower drug prices at their local communities. You can use GoodRx instead of your insurance whenever we're able to offer a lower price than your co-pay.
Why do pharmacies not like GoodRx?
“Pharmacies hate GoodRx's system since they lose money from the potential profit, they would have made from cash paying customers and then also lose money when they pay a fee for selling to a patient who might have used their pharmacy anyway,” says Dr. Fein.
Is CVS a pharmacy benefit manager?
As of 2023, PBMs managed pharmacy benefits for 275 million Americans and the three largest PBMs in the US, CVS Caremark, Cigna Express Scripts, and UnitedHealth Group's Optum Rx, make up about 80% of the market share covering about 270 million people with a market of almost $600 billion in 2024.
What is the problem with PBMs?
PBMs also drive up prescription drug spending by charging insurers a greater amount than they paid to the pharmacy for a drug, a practice known as “spread pricing.” Rather than driving patients to higher-priced drugs, spread pricing keeps some amount of the savings that should accrue to patients.
Does Walgreens have a PBM?
Walgreens Boots Alliance has officially launched its new specialty pharmacy and prescription mail services company with pharmacy benefit manager Prime Therapeutics, a PBM owned by 14 Blue Cross and Blue Shield plans.
How do I find out who my pharmacy benefit manager is?
On the patient's health insurance card, the pharmacy benefit manager will be listed as well.
How does a PBM make money?
Pharmacy Benefit Managers earn profits primarily through administrative fees charged for their services, through spread pricing (the difference between what is paid to pharmacies and the negotiated payment from health plans), and shared savings where the PBM keeps part of the rebates or discounts negotiated with drug ...
What is the difference between a GPO and a PSAO?
GPOs may provide additional client administrative services as well. Pharmacy services administration organization (PSAO): Similar to a GPO, but it serves independent pharmacies. In addition to price negotiation with PBMs, PSAOs offer a variety of administrative services to pharmacies.
What is the lawsuit against GoodRx?
Shortly after the FTC settlement was announced, a class action lawsuit was filed in the U.S. District Court of the Northern District of California against GoodRx that made similar allegations to the FTC – that personal information was disclosed to third parties without users' knowledge or consent, when they had been ...
Can pharmacies refuse to accept GoodRx?
Are pharmacies required to accept GoodRx coupons? Participating pharmacies are required to accept GoodRx through contracts with their pharmacy benefit managers (PBMs). An exception is for controlled medications. Accepting a GoodRx coupon for a controlled medication is always at the discretion of the pharmacist.
Is Walmart no longer accepting GoodRx?
GoodRx discounts are still accepted at Walmart and Sam's Club. If you have issues using a GoodRx discount at a Walmart or Sam's Club, please have the pharmacist call 1-866-921-7286.
How do PBMs hurt pharmacies?
Given this central location of PBMs in price negotiations and drug plan design, they have the ability to integrate manufacturer discounts into these designs without necessarily revealing them to pharmacies. This results in potentially lower profits for community pharmacies.
How does GoodRx make money?
If It's Free, How Does GoodRx Make Money? Although GoodRx is a free service, the company sells its technology, as well as its monthly subscription service, called GoodRx Gold.
What are the top 3 PBM companies?
The analysis lists national-level shares of the 10 largest PBMs. It finds that: The four largest PBMs collectively have a 70% share of the national PBM market. CVS Health is the largest PBM (21.3% market share), followed by OptumRx (20.8%), Express Scripts (17.1%), and Prime Therapeutics (10.3%).
Who owns GoodRx?
Private equity firms Francisco Partners and Spectrum Equity acquired a majority stake in GoodRx in 2015 before a third PE firm, Silver Lake, made a minority investment in 2018.
Which pharmacies are owned by PBMs?
'Patients Before Monopolies'
Each of those PBMs belong to huge healthcare conglomerates that own major insurers and pharmacy networks, too: Caremark by CVS, Express Scripts by Cigna and OptumRx by UnitedHealth.
Is cost plus drugs cheaper than GoodRx?
Discussion. We demonstrate that while use of either GoodRx or CostPlus allows for significant savings, CostPlus offers significantly higher rates of saving, even when isolating the lowest prices from GoodRx.
What is the GoodRx scandal?
According to the FTC's complaint, GoodRx violated the FTC Act by sharing sensitive personal health information for years with advertising companies and platforms—contrary to its privacy promises—and failed to report these unauthorized disclosures as required by the Health Breach Notification Rule.
Who stopped accepting GoodRx?
But throughout much of 2022, GoodRx was embroiled in a dispute with Kroger. The dispute became public in the spring of that year when Kroger suddenly stopped accepting GoodRx discounts.