The news: Capital Rx, a company looking to disrupt the pharmacy benefit manager (PBM) space, raised $400 million, including a $252 million Series F funding round.

Capital Rx markets itself as a transparent PBM, meaning discounts it receives from pharma manufacturers for favorable placement of a drug on a health plan's formulary are passed onto employer and plan clients. For context, the “Big 3” PBMs (CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth’s Optum Rx) have long been accused of engaging in spread pricing and rebate holding for profit.

Zooming out: The Big 3 PBMs control ~80% of the market. They’ve gained significant influence over prescription drug costs and patient access to medications due to their vertical integration with major health insurers. This has allowed the Big 3 to create drug benefit contracts that are often intentionally complex and contain opaque clauses, making it difficult for employer customers to understand their true costs and savings.

Yes, but: As healthcare and prescription drug spending keep rising for self-insured employers and their workers, businesses are increasingly jumping from one of the Big 3 to a newer PBM that promises pricing transparency and a greater share of rebates.

• 31% of employers this year say they use a transparent PBM model, significantly up from 12% in 2024, per a survey this month from the National Alliance of Healthcare Purchaser Coalitions.
• 61% of employers still use one of the Big 3 PBMs, but that’s down from 72% last year.

Disruptor PBMs’ satisfaction scores are already surpassing those of incumbents.

• Big 3 PBMs received an average Net Promoter Score (NPS) of -23 (on a -100 to 100 scale) this year, per a September 2025 Pharmaceutical Strategies Group report. That’s down from an NPS of 3 in 2023 and -2 last year.