Top pbms by market share Jan 1, 2025 · The top three PBMs processed nearly 80 percent of the approximately 6. Sep 10, 2024 · The pharmacy benefit manager (PBM) market was highly concentrated across commercial insurance, Medicare Part D, and Medicaid managed care in 2023, according to a study published in JAMA today. PBMs are a middleman between drug manufacturers and insurers (or employers). 1%), and Prime Therapeutics (10. Jun 17, 2024 · This share was comparable to the large PBMs’ share in 2022. 3% in 2022. Mar 25, 2025 · The American Medical Association reported last year that the four largest PBMs collectively have a 70% share of the market, with CVS Health leading with 21. 4 days ago · Here’s the press release. The three largest PBMs – CVS Caremark (CVS Health), Express Scripts (Cigna), and The U. The report identifies the leading 75 companies in the market and provides comprehensive company profiles on each. Oct 13, 2025 · U. 3% market share. 2% of PBM services). Dominated by major players like CVS Caremark, Express Scripts, and Nov 14, 2025 · Executive Summary Pharmacy Benefit Managers (PBMs) are specialized intermediaries in the U. For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. 3% market share), followed by OptumRx (20. 2% market share), followed by CVS Health (18. Can you put a dollar amount on your medication waste? If not, it's too high Apr 16, 2024 · These six companies together control 96% of the PBM market. Jun 17, 2025 · The Top Pharmacy Benefit Managers of 2024: Market Share and Key Industry Developments (rerun) This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. 5%). MIAMI (March 18, 2025) — Drug Channels Institute (DCI), an HMP Global Company, today released its 2025 Economic Report on U. Pharmacies and Pharmacy Benefit Managers, delving into the crucial commercial, political, financial, and legal forces driving change in the This definitive, nonpartisan resource includes the most current information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, government regulations, and more. Jun 4, 2025 · In 2024, the top pharmacy benefit managers included Cigna, CVS Health, and OptumRx, to name the most important. We estimate that total revenue growth of retail, mail, and specialty pharmacies slowed to 0. where PBMs provide services to commercial health insurers. prescription revenues reach $621 billion, remain highly consolidated with large PBMs. For 2020, DCI estimates that the three biggest PBMs accounted for more than three-quarters of total equivalent prescription claims. Below, you’ll find Drug Channels Institute's latest estimates of pharmacy benefit manager (PBM) market share based on equivalent prescription claims. This statistic shows the market share of the largest pharmacy benefit manager (PBM) in every U. Jan 15, 2025 · The FTC reports that the top three PBMs earned billions from marked-up drug prices, raising concerns about transparency and pricing practices in the pharmaceutical industry. S. Two other PBMs outpaced Optum Rx in 2022: CVS Health/Caremark (33%) and Cigna/Evernorth/Express Scripts (24%). What Do Pharmacy Benefit Managers Do? PBMs affect patients and pharmacies alike. PBMs and payers are adopting diverse tactics to respond to the biosimilars’ market access and formulary strategies. Pharmacy Benefit Management Market was valued at USD 432. 8%. 8%), Express Scripts (17. 90 billion by 2032, and grow at a CAGR of 9. Moving manufacturers’ rebates and discounts to the point of dispensing is a big win for patients, who can share in the savings that pharmacy benefit managers (PBMs) negotiate with drugmakers. Furthermore, concerning the end-user segment, the market is segregated into pharmacy benefit management organization, retail pharmacies, mail order pharmacies, and others. Dec 19, 2022 · Rounding out the roster of the larger players are Humana’s in-house PBM with 8% of market share, Prime Therapeutics with 6% and MedImpact with 4%. Pharmacies of 2023: Market Shares and Revenues at the Biggest Chains and PBMs The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead I’M SPECIAL For 2023, DCI estimates that U. No PBM discloses detailed information about the sources and composition of its profits, so consider my observations as general guidelines for evaluating the upcoming investor day commentary from 4 days ago · Here’s the press release. It was followed by CVS Health with an 18. Jan 31, 2025 · What are the top 3 PBM companies? The analysis lists national-level shares of the 10 largest PBMs. 8% in 2022. Market Share of Top PBMs (2024): The best available figures come from industry sources and analyses. Drug Channels Institute (DCI Mar 31, 2025 · Three pharmacy benefit managers (PBMs) continue to dominate the market, processing nearly 80% of all equivalent prescription claims in 2024. Competitive intensity remains high as vertically integrated PBMs consolidate buying power, even as transparent newcomers chip away at rebate-driven models. PBM services are an input to the production of health insurance services and thus a determinant of health plan premiums. Pharmacy Benefit Management Market Size, Share & COVID-19 Impact Analysis, By Service (Specialty Pharmacy Services, Benefit Plan Design & Administration, Pharmacy Claims Processing, Formulary Management, and Others), By Service Provider (Insurance Companies, Retail Pharmacies, and Standalone PBMs), and Country Forecast, 2023-2030 Jan 14, 2025 · The Federal Trade Commission today published a second interim staff report on the prescription drug middleman industry, which focuses on pharmacy benefit managers’ (PBMs) influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV, and a variety of other critical drugs. Jun 3, 2025 · The pharmacy benefit landscape is evolving rapidly, and 2025 is proving to be a pivotal year. CVS Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (UnitedHealth Group) remain the major players, although shifts in relationships and contracts have caused changes in market share, with Express Scripts taking a leading position. Nine manufacturers began marketing 14 biosimilar versions of Humira, the best-selling pharmaceutical in the U. 9. PBM functions include negotiating rebates with drug manufacturers, assembling retail pharmacy networks, managing drug formularies, adjudicating pharmacy claims and designing drug benefits. Pharmacy Benefit Management Market Size, Share, & Trends Analysis Report by Health Plan: Commercial Health Plans, Medicare Plans, Medicaid Plans, and Others Business Model: Insurance Companies & Retail Pharmacies and Pure Play PBMs Service: Specialty Pharmacy Services, Retail Pharmacy Networks, Mail-Order Pharmacy Services, Claims Processing, Formulary Management, Drug Utilization May 10, 2023 · For more background on these companies’ market positions, check out three of our popular analyses: The Top 15 U. Identify the top three pharmacy benefit managers (PBMs) by market share for 2022 and provide their total prescriptions filled and revenue from pharmacy services. Jul 15, 2024 · The market share of the 3 largest PBMs (CVS Caremark, Express Scripts (ESI), and OptumRx) increased from 70% to 79% of the PBM market. Apr 12, 2023 · For 2022, pharmacy benefits managers (PBMs) and insurers expanded their dominance over specialty dispensing, though both hospitals and physician practices are growing their share of the market. Three Major Players Control 80% of Total PBM Market Share by Total Adjusted Claims. Aug 3, 2025 · The largest PBMs dominate a critical part of health care. 30 billion in 2023, and is expected to reach USD 947. Sep 13, 2024 · The American Medical Association (AMA) has put out a report examining the market share of pharmacy benefit managers (PBMs), the organizations that negotiate drug costs for insurance companies. The lack of transparency in PBM business models is a major point of criticism. A discussion regarding the lack of transparency regarding PBM services, consolidation of the market and vertical integration, as Mar 18, 2025 · New report analyzes market trends, consolidation, and the evolving role of Pharmacy Benefit Managers in the U. It finds that: The four largest PBMs collectively have a 70% share of the national PBM market. Apr 16, 2025 · Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates. UnitedHealth Group's PBM, Optum Rx, accounted for 22% of the 2022 PBM industry with managed claims. PBMs create formularies, negotiate rebates (discounts paid by a drug manufacturer to a PBM) with manufacturers, process claims, create pharmacy networks, review drug utilization, and manage mail Sep 12, 2024 · A new study suggests that major pharmacy benefit managers may be focusing on specific payer segments in a bid to maintain strong market share. In recent years, PBMs have grown into powerful entities controlling a vast share of the drug supply chain. As PBM services have expanded over time, competitive dynamics in the PBM industry have also changed. health care decision-making. 9%), Express Scripts (15. 6%). Apr 16, 2024 · The Top 15 U. May 29, 2019 · Below, I update Drug Channels Institute’s look at PBM market share and reflect on four crucial areas in which PBMs’ compensation will be evolving. Beckerʼs Hospital Review (citing Drug Channels Institute) reports that in 2024 Express Scripts led the market with 30% of total prescription claims, up from 23% in 2023, driven by landing the 20-million-member Centene contract ([1]www Jun 17, 2024 · Three is still the magic number for pharmacy benefit managers (PBMs). Following an extended period of consolidation among PBMs (i. 3% market share, Optum Rx with 20. I. 13% over the forecast period 2024-2032. For 2024, nearly 80% of all equivalent prescription claims were processed by three familiar companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. CVS Caremark led The more things changethe more they stay the same. healthcare system. Nov 3, 2025 · Pharmacy Benefit Management Market Size, Share & Industry Analysis, By Service (Specialty Pharmacy Services, Benefit Plan Design & Administration, Pharmacy Claims Processing, Formulary Management, and Others), By Service Provider (Insurance Companies, Retail Pharmacies, and Standalone PBMs), and Regional Forecast, 2025-2032 The report addresses the following questions: What is the current landscape of the pharmacy benefit manager (PBM) market and which PBMs currently account for the majority of market share? What are the most notable market trends impacting PBMs in 2025? What are PBM executives' most important strategic imperatives? Oct 26, 2022 · At the national level, the analysis found that a handful of PBMs have a large collective market share for the three PBM services most used by insurers: The 10 largest PBMs had a collective share of 97%. , is largely advanced and continues to expand due to rising medicine costs, adding healthcare expenditures, and growing demand for cost-effective drug operation. MALVERN Pa. May 30, 2019 · Top PBMs by market share The PBM market is dominated by three major players, who together handled about 76 percent of all prescription claims in 2018, according to Drug Channels Institute. Browse our extensive list of pharmacy benefit management companies to find the best fit for you. drug industry. The Pharmacy Benefit Management (PBM) industry serves as an intermediary between healthcare payers and the U. The pharmacy benefit management organization sector stands out as the dominant player, holding the largest revenue share of 52. 5%), and Prime Therapeutics (10. Express Scripts accounted for 28% of the commercial market, about double its shares of the Part D and Medicaid markets. The five largest PBMs control 93. Drug Nov 28, 2023 · Among patients whose PBM is not CVS Caremark, Product A achieves a 47% market share in Iowa City, relative to a 37% national market share. prescription dispensing revenues from specialty pharmaceuticals reached $243 billion. In fact, PBM parent companies’ revenue comprised 22% of all US national health expenditure as of 2023. The report found CVS Caremark is the largest PBM by market share, followed by Pharmacy Benefit Managers (PBMs) continue to be strategically focused on better moderating drug spend and utilization while prioritizing membership and the patient experience. The 2025 Economic Report on U. 65 billion in 2025 with a CAGR of 9. May 23, 2023 · Tuesday, May 23, 2023 The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies In 2022, the PBM market remained highly consolidated—although there were some intriguing share shifts among the largest players. 50 billion by 2033, poised to grow at a compound annual growth rate (CAGR) of 5. CVS Caremark leads in PBM market Market Overview The US Pharmacy Benefit Management (PBM) market plays a crucial role in the healthcare system by managing prescription drug benefits for various stakeholders, including employers, health insurance plans, and government programs. Mordor Intelligence expert advisors conducted extensive research and identified these brands to be the leaders in the Pharmacy Benefit Management industry. To help you make sense of recent market Sep 10, 2024 · Newly published data suggests low competition among middling players in the pharmaceutical supply chain, with numbers showing that the four largest pharmacy benefit managers in the country control roughly 70% of the national market. A PBM’s overarching goal is to lower the costs borne by consumers, specifically by lowering prescription drug costs. Discover the best PBM companies with Shortlister. Optum’s largest share was in Part D (27. pharmacies and pharmacy benefit managers (PBMs). Oct 2, 2023 · In The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies, I shared Drug Channels Institute's analysis showing that three pharmacy benefit managers (PBMs)—the Caremark business of CVS Health, the Express Scripts business of Cigna, and the OptumRx business of UnitedHealth Group—accounted for about 80% of In 2023, three major pharmacy benefit managers (PBMs)—CVS Caremark, Express Scripts, and OptumRx—dominated the market, collectively handling 79% of all prescription claims. Significant business relationships among the largest companies continue to Mar 31, 2025 · Three’s still company in the world of pharmacy benefit managers. Jul 31, 2025 · The four largest PBMs collectively had a 67% share of the national PBM market in 2023. Aug 13, 2025 · North America leads the Pharmacy Benefit Management market with 46. 9% share—down from 21. 2% market share—up slightly from 20. Specialty mail order pharmacy is increasing as a share or PBM revenue relative to other channels. Pharmacy benefit managers function as intermediaries between insurance providers and pharmaceutical manufacturers. By the end of 2023, however, the collective market share of these biosimilars remained below 3%. Mar 31, 2025 · Below, we break down the latest market share data from Drug Channels Institute (DCI), explore the developments driving these changes, and examine what they signal for the future of the PBM landscape. Sep 11, 2024 · To further understand PBM market concentration, researchers separately analyzed commercial insurance, Medicare Part D, and Medicaid managed care market strategies of the 3 biggest PBMs. This report lists the top Pharmacy Benefit Management companies based on the 2023 & 2024 market share reports. Jun 10, 2025 · The 340B Drug Pricing Program has emerged as a growing source of profits for pharmacies and pharmacy benefit managers (PBMs). HIRC's report, Pharmacy Benefit Managers: Market Landscape and Strategic Imperatives, reviews the current market landscape, PBM executives' strategic imperatives and objectives, and examines views on top market trends Feb 8, 2022 · Three companies dominate the pharmacy benefit manager market, accounting for 79 percent of all prescription claims in 2020, according to data from Health Industries Research Companies, an Issue Identify the 10 largest health insurers by market share and provide their chief executive officer (CEO) compensation, total number of covered lives, amount of premiums earned, revenue, and net income for 2022. healthcare system that administer prescription drug benefits for insurers, employers, and government programs. Jan 28, 2025 · What are the top 3 PBM companies? CVS Health is the largest PBM (with a 21. 39 billion in 2025, set to expand to USD 752. Pharmacies and Pharmacy Benefit Managers. (ESI), and OptumRx, Inc. 1 Jan 6, 2025 · Newer entrants to the pharmacy benefit management market will continue to face stiff competition in 2025 as they seek more business. For evidence, look no further than Drug Channels Institute's estimates of pharmacy benefit manager (PBM) market share, which are shown in the chart below. Mar 21, 2025 · The top U. Walgreens also lost market share, as we discuss below. 7%. Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the Apr 5, 2022 · The highly-consolidated PBM market notched another year of increased concentration. This 2025 edition of our Economic Report on U. pharmacy in 2024 by market share based on prescription drug revenue was CVS Health Corporation, followed by Walgreens Boots Alliance. They negotiate drug May 14, 2025 · Top PBMs by 2024 market share – RamaOnHealthcare Cigna’s Express Scripts has emerged as the largest pharmacy benefit manager in the U. Sep 9, 2024 · The study dived into 2022 data on commercial and Medicare Part D plans and found that CVS Health's Caremark is the largest PBM, owning 21. Jul 25, 2022 · The highly-consolidated PBM market notched another year of increased concentration. Just Six #PBMs accounted for 96 percent of the market shareand the top three made up 79 percent! Top 3 PBMs = 79% Next 3 PBMs = 17% All Issue Identify the 10 largest health insurers by market share and provide their chief executive officer (CEO) compensation, total number of covered lives, amount of premiums earned, revenue, and net income. Aug 7, 2025 · The shares and rankings for retail network management and claims adjudication were nearly identical. Identify the top three pharmacy benefit managers (PBMs) by market share and provide their total prescriptions filled and revenue from pharmacy services. INTRODUCTION AND GUIDE TO THE 2025 REPORT Since the previous edition of this report, pharmacy and healthcare provider markets continued to experience strong revenue growth amidst a turbulent business and political environment. US PHARMACY BENEFIT MANAGEMENT (PBM) MARKET Retail Prescription Drug Spending US Prescription Drugs – Generic Share Top PBMs by Membership Specialty Prescription Source: Fortune Business Insights The role of Pharmacy benefit managers Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits on behalf of health insurers and large employers and negotiate with drug manufacturers and pharmacies to control costs. OptumRx was the largest PBM in the U. Nebraska Medicine begins $36M proton therapy project Full story 12. PBMs act as intermediaries between pharmacies, drug manufacturers, and payers, facilitating the procurement, distribution, and utilization of Jul 15, 2025 · Pharmacy Benefit Managers (PBMs) are third party companies that function as intermediaries between insurance carriers and pharmaceutical manufacturers. For example, the top three PBMs, Express Scripts, CVS Caremark, and OptumRx, control 80% of the market and are vertically integrated with insurance companies and pharmacies. 29 billion in 2023 and is expected to be worth around USD 853. 7%). For 2021, we estimate that the three biggest PBMs accounted for 80% of total equivalent prescription claims. Drug Channels Institute’s latest exclusive analysis of the 2025 market reveals a highly concentrated market structure increasingly dominated by a handful of major players: About 32,000 pharmacy locations—nearly 60% of the entire U. 7% during the forecast period 2024 to 2033. Make better business decisions, faster with IBISWorld's industry market research reports, statistics, analysis, data, trends and forecasts. 11 billion by 2034 from USD 459. 6 billion prescriptions dispensed by U. PBMs have been reducing the efficiency of the prescription drug marketplace, diverting billions of dollars toward these supply chain middlemen, and increasing costs on employers, consumers, and taxpayers. CVS Health's Caremark holds the largest share with 33 percent. It Jan 15, 2013 · The degree of concentration is comparable to that of 2011, although market share consolidated from six to five pharmacies due to the Express Scripts/Medco Health Solutions merger. 4% in the Pharmacy Benefit Management market. We’ve updated all market and industry data with the most current insights, including our annual analyses of the largest pharmacies, specialty pharmacies, and PBMs. 1% and Prime Therapeutics with 10. , (March 19, 2024) — Drug Channels Institute (DCI), an HMP Global Company, today released its exclusive, in-depth analysis of U. Mar 31, 2025 · The rankings are based on the Drug Channels Institute’s analysis of total equivalent prescription claims managed across the PBM industry in 2024. , controlling the pharmacy benefit of more than 266 million Americans. Sep 10, 2024 · Among PBMs, CVS/Caremark was the dominant player in all three payer markets, while its largest market share was in Medicaid managed care (39. The Pharmacy Benefit Manager ( PBM) request in North America, including the U. PBMs’ market power grew in the late 1990s, largely because of rising expenditures on retail medicines and employers’ desire to control costs. The demand for PBM (pharmacy benefit management) services is on the rise owing to an increase in the AMI’s report, Pharmacy Benefit Managers 2025 Report, specifically focuses on the companies offering PBM products and services. The industry is highly concentrated, with the majority of market share coming from four companies (CVS, Cigna, UnitedHealth Group, and Humana). 3%. Mar 18, 2025 · FUN FACTS ABOUT THE 2025 EDITION The 12 chapters are self-contained—you don't need to read them in order. Continue reading here… Notice: The link provided above connects readers to the full content of the posted article. 6% in 2012. The top PBMs by 2024 market share: Jul 31, 2025 · The largest PDP insurers share ownership with the largest PBMs, including: UnitedHealth Group, first in commercial PDP (13. At the local level, the average PBM market is highly concentrated according to federal antitrust guidelines. Pharmacies of 2022: Market Shares and Revenues at the Biggest Companies DCI’s Top 15 Specialty Pharmacies of 2022: Five Key Trends About Today’s Marketplace PBM Market Share, by Total Equivalent Prescription Claims Managed, 2022 (Exhibit 98 in our 2023 report, but to be Sep 10, 2024 · Among PBMs, CVS/Caremark was the dominant player in all three payer markets, while its largest market share was in Medicaid managed care (39. Mar 18, 2025 · New report analyzes market trends, consolidation, and the evolving role of Pharmacy Benefit Managers in the U. As in prior years, pharmacies linked to the three largest pharmacy benefit managers (PBMs) accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. EXECUTIVE SUMMARY This Interim Report is part of an ongoing study by the Federal Trade Commission (“FTC” or the “Commission”) of pharmacy benefit managers (“PBMs”) and their impact on access to and affordability of medicines. Jun 18, 2024 · The Top 15 U. This report updates OLR Report The pharmacy benefit management (PBM) market demand is driven by the increasing demand for cost management solutions, as organizations seek to control the rising expenses of prescription drugs. Market Overview The Global Pharmacy Benefit Management (PBM) market refers to the industry that manages prescription drug benefits for health insurance plans, employers, and government programs. pharmacy industry—function as Nov 9, 2025 · NORTH AMERICA The region dominates the Pharmacy benefit manager (PBM) market share. Dec 11, 2024 · Discover how PBMs trends can lead the way by embracing transparency, innovation, and cost-effective solutions to meet employer and patient demands. Pharmacies and Pharmacy Benefit Managers provides the most Jan 8, 2025 · Discover the top PBM trends to watch in 2025, from transparency to value-based contracts, and how they impact healthcare costs. , “horizontal” mergers and acquisitions), today just three companies control roughly 80% of the PBM market. It describes how, amidst increasing vertical integration and concentration, these powerful middlemen may be profiting by inflating drug costs and squeezing Mar 7, 2025 · 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. In theory, PBMs are supposed to be helpful, but in practice, they can be harmful. Rising drug costs, increased demand for transparency, and the emergence of new therapies are pushing plan sponsors to rethink how they manage their pharmacy benefit. But beyond the big three PBMs is a swarm of some 60 smaller, up-and-coming PBMs. Pharmacies of 2024: Market Shares and Revenues at the Biggest Chains, PBMs, and Specialty Pharmacies Next week, Drug Channels Institute (DCI) will release our 2025 Economic Report on U. It's followed closely by Jul 31, 2025 · What’s the news: A report from the AMA details how a few firms have a large collective share of the pharmacy benefit manager (PBM) market. This 10-percentage point difference in market share reflects the spillover impact of the dominant PBM, CVS Caremark, on prescribing behavior and which medicines patients in Iowa City receive (#3 and #4). CVS Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (UnitedHealth Group) remain the top players, although recent contract changes and shifting relationships have altered the competitive landscape. Aug 7, 2025 · CVS Health is the largest PBM (21. Based on data from 2022 and 2023, the AMA report—“Competition in PBM Markets and Vertical Integration of Insurers with PBMs: 2025 Update” (PDF May 23, 2023 · Discover the top pharmacy benefit managers (PBMs) of 2022 and their market share according to Drug Channels. May 23, 2023 · In 2022, the PBM market remained highly consolidated—although there were some intriguing share shifts among the largest players. It's a practical, patient-friendly step toward shrinking the gross-to-net bubble that has inflated out-of-pocket costs for 2. Mar 4, 2025 · The competitive landscape of major PBMs, with exclusive market share data from DCI Key business trends among leading PBMs and their impact on the market PBMs’ expanding role in specialty pharmacy and how it’s reshaping the industry Exclusive insights into the Federal Trade Commission’s interim reports and the future of its investigation 5 days ago · The opacity and misaligned incentives that plague the PBM market are currently harming patients. We also calculated market share for the top 5 PBMs (CVS Caremark, Express Scripts, Optum Rx, MedImpact, and SS&C Health) by payer type (secondary outcomes). The data revealed “low competition among these middlemen in the pharmaceutical supply chain and high vertical integration of PBMs with health insurance companies,” the AMA said in a statement Apr 5, 2022 · Three major players dominate the pharmacy benefit manager market, accounting for 80 percent of all prescription claims handled in 2021, according to the Drug Channels Institute. Apr 6, 2021 · The drug channel is consolidating, both vertically and horizontally. Explore top pharmacy benefit management companies, including Express Scripts and Optum, revolutionizing healthcare access and affordability across the US. 5 All of the top six PBMs are vertically integrated downstream, operating their own mail order and specialty pharmacies, while one PBM owns and operates the Oct 16, 2025 · The U. 8%, Express Scripts with 17. Nov 13, 2025 · PBMs control a large market share, with CVS Health, Cigna, and UnitedHealth Group being major players. The analysis found significant vertical integration between insurers and PBMs. Mar 31, 2025 · Share To Three major pharmacy benefit managers (PBMs) continue to dominate the market, processing nearly 80% of all equivalent prescription claims in 2024. Here’s why: ‍ 1. e. Jun 17, 2025 · Tuesday, June 17, 2025 The Top Pharmacy Benefit Managers of 2024: Market Share and Key Industry Developments (rerun) This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: What’s Next for Retail Pharmacy: Data, Debate, and Disruption. Sep 11, 2024 · Major PBMs could be zeroing in on specific payer markets for dominance, study suggests New research into PBMs’ market strategies could inform lawmakers looking to reform the industry. The new 2024 Economic Report on U. Sep 10, 2024 · We analyzed PBM market share and market concentration by payer type (primary outcomes) for all prescriptions filled in 2023. Consider Drug Channels Institute's latest estimates of pharmacy benefit manager (PBM) market share, shown in the chart below. I also provide commentary on recent market developments and offer some helpful tips for interpreting the figures May 13, 2025 · Who are the big 3 pharmacy benefit managers? Staff's latest report found that the 'Big 3 PBMs'— Caremark Rx, LLC (CVS), Express Scripts, Inc. These data appear in Chapter 5 of our new 2024 Economic Report on U. . The collective share of the four largest PBMs in the national commercial market jumped four percentage points from 64% in 2020 to 68% in 2021, largely due to the CVS Health acquisition of Aetna, which had owned its own PBM. Who are the Big 3 healthcare distributors? AmerisourceBergen, Cardinal Health, and McKesson have acquired specialty drug distributors to increase their share of the specialty drug market, and specialty drugs now account for Jan 13, 2025 · Years of dominance by the three major vertically integrated pharmacy benefit managers that control the bulk of the market have placed great strain on the healthcare industry. Pharmacies and Pharmacy Benefit Managers retains the overall structure of last year’s edition. WHO OWNS THE PBMs? The top five pharmacy benefit managers are owned by companies that also offer insurance and other healthcare services. Sep 9, 2024 · It finds that: The four largest PBMs collectively have a 70% share of the national PBM market. Expert industry market research on the Pharmacy Benefit Management in the US (2015-2030). in 2023 with a 22. (Really!) There are tons of internal hyperlinks to help you navigate and focus on what matters most to you. This new 16th edition integrates information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, government regulations, and wholesalers. In addition, the rise of chronic diseases like diabetes and heart disease is leading to greater medication use, aiding the market growth. Mar 11, 2025 · Tuesday, March 11, 2025 The Top 15 U. Jun 18, 2025 · Below, we share DCI’s latest analysis of the top 15 specialty pharmacies, including updated market shares and revenue estimates. PBMs act as intermediaries between insurers, pharmacies, and pharmaceutical manufacturers to optimize drug utilization, ensure cost-effectiveness, and improve patient outcomes. As per the National Association of Insurance Commissioners, around 66 PBM companies are operating in the U. 3% revenue share, while Asia Pacific records the fastest growth as coverage expands in China and India. Mar 19, 2024 · Report: U. by market share, overtaking long-time leader CVS Caremark, according to a March 31 report from the Drug Channels Institute. 3%). Provision This provision would amend Section 1150A of the SSA to expand the type of entities that must report data to the HHS Secretary to include certain PBM affiliates, to add data Apr 1, 2025 · Top PBMs by 2024 market share Full story 11. At MedOne, we’ve identified the following five key trends that are reshaping the PBM space and what they mean for your organization. pharmacy benefit management market size is expected to hit around USD 1,041. 1. Oct 29, 2021 · Evolution of the PBM Landscape As noted in Part I, PBMs are organizations that provide negotiating leverage, benefit administration, and contracting expertise to their health plan and employer clients. Based on 2020 data for people with a commercial drug benefit tied to a medical benefit and the PBMs used Pharmacy Benefit Managers, or PBMs, are largely unrecognized by most employees and even many employers, but they have a tremendous impact on U. Mar 31, 2025 · Share To Three pharmacy benefit managers (PBMs) continue to dominate the market, processing nearly 80% of all equivalent prescription claims in 2024. Dec 5, 2023 · Here's how the six largest health insurance companies and their pharmacy benefit manager companies stack up. 6 days ago · We draw extensively on industry reports, academic studies, regulatory filings, and news coverage to give a comprehensive, evidence-based picture of how these three PBMs dominate the market and what that means for the healthcare system. 88 billion by 2033, at a CAGR of 4. The PBM market is dominated by three major players, who together handled about 76 percent of all prescription claims in 2018, according to Drug Channels Institute. 1%) and Prime Therapeutics (10. For example, PBM ensures that 72% of people get a commercial or Oct 27, 2025 · pharmacy benefit management (pbm) market size is estimated at USD 519. Aug 7, 2024 · American Medical Association What’s the news: The AMA has gathered first-of-its-kind data on pharmacy benefit managers (PBMs) and its analysis finds a widespread high degree of market concentration in local markets across the U. In 2024, Express Scripts handled 30% of all prescription claims, up significantly The U. The AMA published its annual analysis of PBM market competition on Sept. The 4 largest PBMs have a collective national market share of 67%. Pharmacies and Pharmacy Benefit Managers delves into all the crucial commercial, political, financial, and legal forces Sep 9, 2024 · The four largest pharmacy benefit managers in the United States control 70% of the national market, according to new data from the AMA. Mar 31, 2025 · Drug Channels Drug Channels Learn more Monday, March 31, 2025 The Top Pharmacy Benefit Managers of 2024: Market Share and Key Industry Developments Three’s still company in the world of pharmacy benefit managers. CVS Health is the largest PBM (21. The top three PBM-owned specialty pharmacies accounted for nearly two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. pharmacy benefit management market size was estimated at USD 490. 4%) markets and third in the stand-alone PDP market (18. (1) Over the past decade, the negotiating Sep 10, 2024 · The four largest pharmaceutical benefit managers account for 70% of the market, an analysis from the American Medical Association found. 1 In recent years, each of these three large PBMs have affiliated with health insurers, specialty and mail order acquisition of certain downstream PBM affiliates that serve as rebate negotiators and aggregators for a growing share of the PBM market. The U. 6% of the Part D market – much This article reviews how pharmacy benefit managers (PBMs) play a role in the delivery of modern healthcare services. Inflate Drug Costs Sep 11, 2024 · To further understand PBM market concentration, researchers separately analyzed commercial insurance, Medicare Part D, and Medicaid managed care market strategies of the 3 biggest PBMs. pharmacies in 2023, while the top six PBMs processed more than 90 percent. 2%) and Medicare Advantage PDP (29. Many sections Mar 26, 2024 · ‍To put it in perspective, three of the biggest PBMs — CVS, Cigna, and Optum Rx — account for nearly 80% of the industry’s market share. OptumRx is the largest PBM (22. This indicates that only a few PBMs supplied insurers with PBM services and suggests low competition among PBMs. It's a practical, patient-friendly step toward shrinking the gross-to-net bubble that has inflated out-of-pocket costs for May 23, 2023 · News Caremark, Express Scripts and OptumRx dominate as top PBMs of 2022 While the top three PBMs’ aggregate share of claims was similar to the figures from 2021, the study indicated that Cigna’s share declined due to customer losses while OptumRx’s share grew slightly. A breakdown of PBM market share, by total equivalent prescription claims managed in 2018: Continue reading article here… May 9, 2024 · Three pharmacy benefit managers accounted for nearly 80% of all prescription claims handled in 2023, according to an April 9 report from the Drug Channels Institute.