Over the past decade, the Pharmacy Benefit Management marketplace has consolidated into three national PBMs (Express Scripts, CVS Caremark, UnitedHealth/Optum Rx), controlling approximately 75%-80 of the market.
The market consolidation has given these three companies leverage to negotiate large discounts from drug manufacturers. The industry has seen the PBMs retain the discounts rather than passing them along to the health plan/employer. This has increased focused attention on PBMs, now referred to as “middlemen” in the drug market.
The market is shifting from the traditional PBM business to an evolving model for the larger PBMs that will see them becoming more aligned with payers, focus on transparency, increase innovation in tools and services, negotiate new contracting models, and initiate an increasing number of mergers and acquisitions. Industry stakeholders will evolve while continuing to monitor Amazon’s activities.
AMI’s Pharmacy Benefit Industry Reports will provide you all necessary information to develop strategies for product and service success. AMI’s Reports include: