Federal NAICS Codes

NAICS 524292: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

Explore obligations, trends, recent awards, and incumbent contractors for NAICS 524292.

NAICS 524292 federal market metrics

Total obligations
$8B
Total awards
1,634 awards
Active obligations
$349.6M
Size standard
$45,500,000 receipts

What this NAICS covers

NAICS 524292 covers third-party administration services for pharmacy benefits and related insurance or pension programs, including claims adjudication, formulary and utilization management, pharmacy network contracting, rebate and payment processing, and reporting for benefit administration.

Federal opportunities under 524292 typically involve administering beneficiary pharmacy programs to control costs and access, operating claims adjudication workflows, managing formularies and prior authorization, reconciling rebates and payments, producing compliance and utilization reports, and ensuring network pharmacy performance.

FY2025 snapshot

Obligations
$787.8M
Awards
131
Average award
$6M
Change from FY2024
+18.9%

Recent awards

Search contractors

$58,191

HEALTHEQUITY, INC.

USDA, Departmental Administration

PIID
12314426F0244
PSC
R711 - SUPPORT- MANAGEMENT: BANKING

FAQ

What work fits NAICS 524292?
  • Administering pharmacy claims processing including electronic adjudication, remittance advice generation, and financial reconciliation for pharmacy expenditures.
  • Managing a pharmacy network with credentialing, contract rate administration, and provider reimbursement reconciliation.
  • Operating prior authorization and utilization management programs that enforce clinical criteria through electronic workflows and documented approval logs.
  • Producing monthly and audit-ready claims and financial reports detailing pharmacy spend, claim counts, and formulary change impact analysis.
When is NAICS 524292 a weak fit?
  • Insurance underwriting and risk assumption - missing assumption of insurance risk, premium setting, and insurer financial exposure responsibilities.
  • Wholesale drug distribution and logistics - missing physical distribution, warehousing, cold-chain handling, and inventory management of pharmaceutical products.
  • Direct clinical pharmacy services in a medical facility - missing hands-on medication therapy management, dispensing at point of care, and direct patient counseling as primary scope.
What solicitation language points to NAICS 524292?
  • Solicitation lists labor categories like claims adjudicator, pharmacy network manager, utilization review pharmacist, and claims operations administrator with required certifications.
  • Deliverables specify electronic claims file formats, routine claim reconciliation reports, formulary change logs, and audit-ready financial reconciliations.
  • Evaluation criteria reference capability in electronic claims interchange standards, patient-data security protections, and prior performance on third-party pharmacy administration contracts.

Put this market knowledge to work

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