Spotlight on PBMs: 2019 Annual Review. AMI’s 2019 Annual Review of Pharmacy Benefit Managers (PBMs) finds leading participants developing and implementing strategies to succeed in a market where they are under increasing scrutiny for the role they play in the high prices of drugs in today’s market.
Over the past decade, the PBM marketplace has consolidated into three national PBMs (Express Scripts/Cigna, CVS Caremark/Aetna, UnitedHealth/Optum Rx), controlling more than two-thirds of the market. The past year has seen the combination of Cigna and Express Scripts and CVS Health/Aetna as PBMs are vertically integrating with health plans.
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.
The market is shifting from the traditional PBM business to an evolving model for the larger PBMs that will see them:
- Aligned more with payers
- Be more focused on transparency
- Negotiate new contracting models
- Initiate more mergers and acquisitions
- Increase innovation in tools and services
- Increase wariness on Amazon’s activities
AMI’s new report answers the following:
- What is the background of the pharmacy benefit management market?
- How are PBMs compensated and what role do they play in drug pricing?
- Who are the current market-leading PBMs and what is their strategies to succeed?
- What are Drug Aggregators and what role do they play in the market?
- What are Copay Accumulator programs?
- What new programs and services are PBMs implementing?
AMI’s report, Spotlight on PBMs: 2019 Annual Review, identifies the major players in the PBM market and offers insights on the strategies they are implementing. The Table of Contents:
PBM Background – pgs. 4-8
Companies – pgs. 9-45
- Express Scripts/Cigna – pgs. 9-15
- CVS Caremark/Aetna – pgs. 16-19
- OptumRx/United Health – pgs. 20-23
- Prime Therapeutics – pgs. 24-26
- Humana Pharmacy – pgs. 27-28
- EnvisionRxOptions/Rite Aid – pgs. 29-30
- MedImpact Healthcare Systems – pgs. 31-32
- Envolve Pharmacy Solutions/Centene – pgs. 33-35
- Perform Rx – pgs. 36-37
- CastiaRx/Diplomat – pgs. 38-39
- Magellan Rx Management – pgs. 40-41
- IngenioRx/Anthem – pgs. 42-43
- Amazon – pg. 44
- References – pg. 45