The American Medical Association's analysis reveals a significant lack of competition among Pharmacy Benefit Managers (PBMs) and high levels of vertical integration within the market. In 2023, OptumRx led the PBM market with a 22.2% share, followed by CVS Caremark (18.9%), Express Scripts (15.5%), and Prime Therapeutics (10.6%), collectively capturing 67% of the market. High vertical integration was also evident, with 77% of enrollees in plans where insurers are integrated with PBMs. Most major PBMs are affiliated with health insurers, raising concerns over accountability and the potential rise in drug prices.
"As PBMs increasingly act in their own self-interest without transparency or accountability, drug prices rise and patients face health risks from cost prohibitive drug treatments."
"The AMA found that OptumRx was the largest PBM in the U.S. in 2023 with a 22.2% share in the rebate negotiation market, followed by CVS Caremark with an 18.9% market share."
#pharmacy-benefit-managers #drug-pricing #healthcare-market #vertical-integration #american-medical-association
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