AmeriHealth Caritas to Shutter PerformRx PBM Unit by Year-End, Outsourcing Services to OptumRx
Medicaid insurer AmeriHealth Caritas has announced it will close its internal pharmacy benefit manager (PBM), PerformRx, by the end of 2026. The Philadelphia-based insurer confirmed it will transition its pharmacy benefit services to OptumRx, a subsidiary of UnitedHealth Group, effectively exiting the PBM management space to rely on one of the industry’s dominant players.
Strategic Shift Amid Financial Pressures
The decision to shutter PerformRx follows a period of financial headwinds for AmeriHealth Caritas. After reporting a $368 million profit in 2023, the insurer swung to a net loss of $199 million in 2024. This downturn has been attributed largely to the “unwinding” of Medicaid rolls—a nationwide redetermination process that removed millions of beneficiaries from government-sponsored health plans—and a failure to secure key new state Medicaid contracts.
AmeriHealth Caritas, which is jointly owned by Independence Health Group (parent of Independence Blue Cross) and Blue Cross Blue Shield of Michigan, had already initiated cost-cutting measures prior to this announcement. In mid-2024, the company laid off approximately 1% of its workforce, citing the need to adjust administrative costs in response to falling enrollment numbers.
Industry Context: The Squeeze on Mid-Sized PBMs
PerformRx, founded in 1999, specialized in managing pharmacy benefits for Medicaid and Medicare populations. However, its closure highlights the increasing difficulty for mid-sized PBMs to compete against the “Big Three”—CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx. Together, these three conglomerates process roughly 80% of all prescription claims in the United States.
By outsourcing to OptumRx, AmeriHealth Caritas gains access to the massive purchasing power and scale of a market leader, ostensibly to lower drug costs for its remaining members. However, this move further consolidates the PBM market, reducing the number of independent options available to health plans.
Objections and Concerns
The transition raises several concerns regarding market competition and employment:
Market Concentration: Critics of the PBM industry argue that vertical consolidation leads to opaque pricing and fewer choices for consumers. By folding PerformRx’s volume into OptumRx, the market becomes even more top-heavy, potentially reducing the leverage of smaller payers and independent pharmacies.
Operational Disruption: While the transition is scheduled for the end of the year, shifting pharmacy benefits for millions of Medicaid recipients carries operational risks, including potential disruptions in medication access during the handover.
Workforce Impact: The closure of PerformRx puts existing staff at risk. While AmeriHealth Caritas has previously offered severance and placement assistance during layoffs, it is unclear how many PerformRx employees will be absorbed by the wider company or OptumRx, versus how many positions will be eliminated entirely.
Background on the Companies
AmeriHealth Caritas: A national leader in Medicaid managed care, serving millions of members across 13 states and the District of Columbia.
PerformRx: An internal PBM created to manage drug costs specifically for the complex needs of Medicaid and Medicare populations, offering clinical programs and utilization management.
OptumRx: The pharmacy care services business of UnitedHealth Group, one of the largest healthcare companies in the world, known for its deep integration with insurance and provider services.
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