The Pharmacy Benefit Management (PBM) marketplace has consolidated over the past decade, resulting in three market-leading PBMs: Express Scripts/Cigna, CVS Caremark, UnitedHealth/Optum Rx) controlling approximately 75% of the market.
Ongoing consolidation in the PBM market has resulted in a small number of larger players that are able to leverage their size for more negotiating power with insurers and drug makers. PBMs, commonly referred to middlemen in today’s market, have been able to obtain significant influence over pricing and competition.
In another example of the market’s trend of consolidation, Express Scripts recently agreed with Prime Therapeutics (Prime) to negotiate with pharmaceutical manufacturers on its behalf for three years, resulting in increased leverage for them with manufacturers and pharmacies.
The scrutiny on the role PBMs play in drug pricing has increased focus on the industry and is driving the larger PBMs to leverage new revenue streams. This includes increasing the focus on their specialty pharmacies, which offer increased profitability as PBMs often require health plan members to fill their prescriptions at PBM-owned specialty pharmacies.
The increased market consolidation has also left room for mid-market PBMs to reinforce their place in the market and the launching of non traditional PBMs looking to establish their niche.
AMI’s report provides the background and current landscape on the market. The report also provides profiles on the Market Leaders, Mid-Market PBMs, and Non-Traditional PBMs. Each profile includes: company background, strategy, financial information, products and services and recent activities. The Table of Contents include:
PBM Market
- Background – pg. 5
- Current Landscape – pg. 6
PBM Market Leaders
- Express Scripts/Cigna – pgs. 8-13
- CVS Health/Aetna – pgs. 14-19
- OptumRx/UnitedHealth Group – pgs. 20-24
- Prime Therapeutics – pgs. 25-29
- Humana Pharmacy – pgs. 30-32
- EnvisionRxOptions/Rite Aid – pgs. 33-36
- MedImpact Healthcare Systems – pgs. 37-39
- Envolve Pharmacy Solutions/Centene – pgs. 40-43
- Perform Rx – pgs. 44-45
- Magellan Rx Management – pgs. 46-49
- IngenioRx/Anthem – pgs. 50-51
Mid-Market PBMs
- BeneCard PBF – pgs. 53-54
- EHIM – pgs. 55-56
- Integrated Prescription Management – pg. 57
- Kroger Prescription Plans – pgs. 58-59
- MaxorPlus – pgs. 60-61
- MC-Rx – pgs. 62-63
- Pharmacy Benefit Dimensions – pgs. 64-65
- Serve You Rx – pgs. 66-67
- WellDyne – pgs. 68-69
Non Traditional PBMs
- Alluma – pg. 71
- Amazon – pg. 72
- Capital Rx – pgs. 73-74
- CerpassRx – pgs. 75-76
- CitizensRx – pgs. 77-78
- EmpiRx Health – pgs. 79-80
- MedOne – pg. 81
- Navitus – pgs. 82-83
- PharmPix – pgs. 84-85
- RxAdvance – pgs. 86-87
- RxPreferred – pgs. 88-89
- RxSense – pgs. 90-91
- SmithRx – pg. 92