EXHIBIT 10.80

                 SIXTH AMENDMENT TO EMPLOYMENT AGREEMENT BY AND
               BETWEEN NATIONAL MEDICAL HEALTH CARD SYSTEMS, INC.
                                 AND JAMES BIGL


     This Sixth  Amendment dated October 30, 2003 and effective upon the Closing
Date (as such term is defined in the Purchase Agreement (as defined below)) (the
"Effective  Date") is by and among National  Medical Health Card Systems,  Inc.,
(the  "Company")  and James Bigl  ("Employee").  All defined terms used, but not
otherwise defined herein,  shall have their meanings set forth in the Employment
Agreement,  as  amended,  between  Company  and  Employee  dated May 3, 2000 and
amended  July 18,  2001 and as further  amended on April 15,  2002,  October 14,
2002, November 6, 2002 and October 1, 2003 respectively (the "Amended Employment
Agreement").

                                   WITNESSETH:

     WHEREAS,  the Company and Employee have entered into the Amended Employment
Agreement; and

     WHEREAS, the Company and New Mountain Partners, L.P. (the "Purchaser") have
entered into the Preferred  Stock  Purchase  Agreement,  dated as of _______ __,
2003, pursuant to which the Company will issue and sell to the Purchaser and the
Purchaser  will  purchase  from the  Company  ________  shares  of the  Series A
preferred  stock  of the  Company  (the  "Series  A  Preferred  Stock"),  for an
aggregate purchase price of $80,000,003 (as the same may be amended prior to the
Closing Date, the "Purchase Agreement");

     WHEREAS,  the  Purchaser and the Company have  required,  as a condition to
consummating the transactions  contemplated in the Purchase Agreement,  that the
Employee enter into this Amendment;

     WHEREAS,  the  Company  has  granted the  Employee  the  following  options
(collectively  referred to herein as the "Existing  Options"):  (a) an option to
acquire  100,000  shares of the  Company's  Common Stock at a price per share of
$4.00 pursuant to a stock option  agreement  dated June 12, 2000 (the "June 2000
Option");  (b) an option to acquire 11,000 shares of the Company's  Common Stock
at a price  per  share of  $1.67  pursuant  to a stock  option  agreement  dated
February 20, 2001 (the  February  2001  Option) (c) an option to acquire  20,000
shares of the Company's Common Stock at a price per share of $3.00 pursuant to a
stock  option  agreement  dated June 12, 2001 (the "June 2001  Option");  (d) an
option to acquire  100,000  shares of the Company's  Common Stock at a price per
share of $9.00  pursuant to a stock option  agreement  dated April 30, 2002 (the
"April 2002 Option");  (e) an option to acquire  350,000 shares of the Company's
Common Stock at a price per share of $9.45 pursuant to a stock option  agreement
dated  June 26,  2002 (the  "June  2002  Option");  and (f) an option to acquire
50,000  shares  of the  Company's  Common  Stock at a price  per share of $10.47
pursuant  to a stock  option  agreement  dated  July 22,  2003 (the  "July  2003
Option");

     WHEREAS,  the  Company  and  the  Employee  desire  to  amend  the  Amended
Employment Agreement to provide for the continued employment of the Employee by
the Company as its Chief Executive Officer from and after the Closing Date on
the terms and conditions set forth herein.

     NOW,  THEREFORE,  in  consideration  of the mutual  covenants  and promises
contained herein, the parties agree as follows:

     1. Section 3.1(b) of the Amended  Employment  Agreement shall be deleted in
its entirety.

     2. Section 3.5 of the Amended  Employment  Agreement  shall be amended such
that the last sentence shall be replaced with the following:

     For the  purposes of this  paragraph  Change of Control  shall mean (i) the
acquisition  by any  Person or  Persons  acting as a group  (other  than (a) any
existing  shareholder  of the  Company  holding  more  than 4% of the  Company's
outstanding  Common Stock as of the date hereof or (b) the Purchaser)  following
the Closing Date of more than 50% of the  Company's  outstanding  voting  stock;
(ii) the  merger  of the  Company  with or into  another  corporation  where the
Company is not the surviving entity and the Company's  shareholders  immediately
prior to the merger do not have the right to elect a majority  of the members of
the  Board of the  surviving  entity;  (iii)  any  reverse  merger  in which the
Company's shareholders  immediately prior to the merger do not have the right to
elect a majority of the members of the Board of the  surviving  entity;  or (iv)
the sale of all or substantially all of the assets of the Company.

     3. Section 3 of the Amended  Employment  Agreement  shall be amended to add
section 3.6 which shall state the following:

     (a)  Notwithstanding the provisions of Section 3.5, the consummation of the
transaction  contemplated  by  Purchase  Agreement  shall  not be deemed to be a
Change of Control and the Employee  shall not be entitled to any payments  under
this  Section  3.5  as  a  result  of  the   consummation  of  the  transactions
contemplated by the Purchase Agreement.

     (b) On the  Closing  Date (as  defined in the  Purchase  Agreement)  of the
transactions  contemplated by the Purchase Agreement, the Employee shall receive
a cash  payment  of  $500,000  from  the  Company.  Subject  to  any  applicable
restrictions  under state or federal  securities laws and the Company's policies
regarding purchases and sales of the Company's securities by Company executives,
the  Employee  shall  purchase on the open  market or in a privately  negotiated
transaction a number of shares of common stock of the Company  ("Common  Stock")
having an aggregate purchase price of $250,000 (the "Employee Stock") during the
period  beginning on the day after the Closing Date and ending on the  one-month
anniversary  of the date of the  Company's  first  quarterly or annual  earnings
release issued after the Closing Date.

     (c) The Employee shall notify the Company promptly  following any purchases
of Employee  Stock in  accordance  with  Section  3.6(b),  and such notice shall
include the date,  dollar  amount and number of shares with respect to each such
purchase.  The Employee hereby agrees not to sell, transfer,  assign,  exchange,
pledge,  encumber or otherwise dispose of any shares of the Employee Stock until
such time as the Purchaser  sells to a third party unrelated to the Purchaser (a
"Third Party") all or a portion of the Series A Preferred  Stock or Common Stock
received upon conversion of the Series A Preferred Stock (the Series A Preferred
Stock and the Common Stock received upon such  conversion are referred to herein
as "Investor Shares").  At such time as the Purchaser sells Investor Shares to a
Third Party,  the Employee  shall be entitled to sell or otherwise  dispose of a
proportionate  number of shares of the  Employee  Stock (as provided for in this
Section 3.6(c)) free of the  restrictions of this Section 3.6(c) (but subject to
all appropriate  limitations and prohibitions under applicable securities laws).
The Employee will be entitled to sell or otherwise  dispose of, pursuant to this
Section 3.6(c), the same percentage of the Employee Stock as the Purchaser sells
of its  Investor  Shares  (determined  on the basis of the  aggregate  number of
shares of Common Stock owned by the Purchaser  and the aggregate  number of such
shares of Common  Stock  being  sold by the  Purchaser  (treating  all  Series A
Preferred Stock as converted into shares of Common  Stock)).  In connection with
any sale by  Purchaser  to a Third Party of the  Investor  Shares that have been
converted  into shares of Common Stock by  Purchaser,  the Company  shall afford
Employee the right to participate in and sell a  proportionate  number of shares
of the Employee Stock as part of such transaction and sell an amount of Employee
Stock equal to the same  percentage of the Employee Stock as the Purchaser sells
of its  Investor  Shares  (determined  on the basis of the  aggregate  number of
shares of Common Stock owned by the Purchaser  and the aggregate  number of such
shares of Common  Stock  being  sold by the  Purchaser  (treating  all  Series A
Preferred  Stock as converted into shares of Common  Stock)).  The Company shall
notify the Employee in writing of the  Purchaser's  sale of Investor Shares to a
Third Party within ten business days after obtaining knowledge of such sale.

     4. Section 3.5 as added to the Amended Employment Agreement pursuant to the
Fifth  Amendment to the Employment  Agreement,  dated October 1, 2003,  shall be
renumbered Section 3.7 of the Amended Employment Agreement and shall be replaced
with the following:

     The Company shall afford Employee the right to be a selling  shareholder in
connection  with any  offering  of equity  securities  by the Company or another
selling   shareholder  with  which  the  Company  cooperates  so  long  as  such
participation is not in conflict or inconsistent with any other agreement of the
Company in effect on the date hereof, provided that Employee may only sell up to
one third of the shares held by Employee and further provided that such sales by
Employee has been consented to by the lead Underwriter of the offering.

     5. Section 4 of the Amended  Employment  Agreement  shall be amended to add
Section 4.5 which shall state the following:

     On the Closing Date all of the Existing  Options not currently vested shall
become fully vested and be freely  exercisable  in accordance  with their terms;
provided  however,  that Employee shall be restricted  from  exercising  certain
Existing Options as set forth below:

                  (i) with respect to the Existing Option to acquire 100,000
                  shares of the Company's Common Stock pursuant to the April
                  2002 Option, (a) 66,000 Options shall be freely exercisable,
                  in the Employee's sole discretion, and (b) Employee shall be
                  restricted from exercising 34,000 shares underlying such
                  option until April 30, 2004;

                  (ii) with respect to the Existing Option to acquire 350,000
                  shares of the Company's Common Stock to the June 2002, such
                  option shall become exercisable with respect to one-third of
                  the shares on June 12, 2004 and an additional one-third of the
                  shares subject to such option on each of the first two
                  anniversaries of that date; and

                  (iii) with respect to the Existing Option to acquire 50,000
                  shares of the Company's Common Stock pursuant to the July
                  2003, such option shall become exercisable with respect to
                  one-third of the shares on June 12, 2004 and an additional
                  one-third of the shares subject to such option on each of the
                  first two anniversaries of that date.

     Furthermore,  in the event that the Employee's  employment with the Company
terminates, for any reason, each of the Existing Options, to the extent not then
exercisable,  shall become  immediately  exercisable  by Employee on the date of
such termination; provided, however, that, if the Employee's employment with the
Company is terminated  (a) by the Company  pursuant to Section 5.2 or (b) by the
Employee  other than for Good Reason,  the Company shall have the right to elect
to  unilaterally  amend  each of the  Existing  Options,  to the extent not then
exercisable  (without giving effect to the accelerated  exercisability  provided
for in this paragraph),  such that each such option will not become  immediately
exercisable  by Employee on the date of such  termination  and will  instead (x)
remain  outstanding  until such  option's  expiration  date and (y)  continue to
become exercisable pursuant to the schedule set forth in this Section 4.5.

     In addition,  all of the restrictions on exercise contained in clauses (i),
(ii) and (iii) of this  Section  4.5 shall  lapse and be of no further  force or
effect upon any Change of Control  after the Closing Date without  regard to the
Employee's employment status.

     6.  Section 5.1 of the  Amended  Employment  Agreement  shall be amended by
replacing the last sentence of Section 5.1 with the following:

         Notwithstanding the definition of disabled contained in the preceding
         sentence, in the event that the Employee is receiving disability
         insurance benefits during any period prior to the termination of his
         employment with the Company as provided in this Section 5.1, the
         Employee's salary shall be reduced by an amount equal to such
         disability insurance benefits during such period.

         7. Section 5.2 of the Amended Employment Agreement shall be amended by
replacing the first paragraph of Section 5.2 with the following:

         The Company, in addition to any other remedies available to it, either
         at law or in equity, may terminate the Employee's employment with the
         Company without any further liability or obligation to the Employee
         under this Agreement from and after the date of such termination, by
         delivering to Employee written notice upon the occurrence of any of the
         following events:

         8. Section 5 of the Amended Employment Agreement shall be amended to
add section 5.5 which shall state the following:

                  Notwithstanding anything in this Amended Employment Agreement
         to the contrary, in the event that the Employee's employment with the
         Company terminates for any reason prior to the eighteen-month
         anniversary of the Closing Date, the Employee (or in the event of his
         death his surviving spouse or if none his estate) shall be entitled to,
         in addition to any other benefits or compensation provided for in this
         Section 5 or in the Amended Employment Agreement, a lump sum cash
         payment of $624,000. In the event that, prior to the eighteen-month
         anniversary of the Closing Date, either (a) the Company terminates the
         Employee's employment with the Company for a reason other than those
         set forth in Section 5.2 hereof or (b) the Employee terminates his
         employment with the Company for Good Reason, then the Employee shall be
         entitled to, in addition to any other benefits or compensation provided
         for in this Amended Employment Agreement (including the payment
         specified in the preceding sentence), an additional lump sum cash
         payment of $250,000.

     9. Section 7.1 of the Amended  Employment  Agreement shall be amended shall
be replaced with the following:

                  The Employee covenants and undertakes that during the
         Employment Period and thereafter until the date that is three (3) years
         after the date of the Employee's termination of employment with the
         Company, he will not, whether for his own account or for the account of
         any other person, firm, corporation or other business organization,
         interfere with the Company's relationship with, or endeavor to entice
         away from the Company any person, firm, corporation or other business
         organization who or which at any time during the Employee's employment
         with the Company was an employee, consultant, agent, supplier, customer
         or active prospect of the Company or in the habit of dealing with the
         Company.

     10.  Employee  hereby  agrees  that he will not  tender  any  shares to the
Company, or otherwise  participate in, the Offer (as such term is defined in the
Purchase Agreement).

     11. Except as expressly  provided  herein,  all terms and conditions of the
Amended Agreement shall be unmodified and in full force and effect.

     12.  From and after the  Effective  Date,  all  references  to the  Amended
Agreement  contained in other agreements and instruments  executed and delivered
pursuant to or in connection with the Agreement shall hereinafter mean and refer
to the Amended Agreement as amended hereby.

     13. This Amendment may be executed in  counterparts  by the parties hereto,
all of  which  shall  constitute  one  and  the  same  instrument.  A  facsimile
transmission of this signed  amendment  bearing a signature on behalf of a party
hereto shall be binding on such party.

     IN WITNESS  WHEREOF,  the Company and  Employee  have  executed  this Sixth
Amendment the day and year first above written.

                                     NATIONAL MEDICAL HEALTH CARD SYSTEMS, INC.


                                        ______________________________________
                                     By: Bert E. Brodsky, Chairman of the Board


                                       ____________________________
                                         James Bigl