Pharmacy Benefit Managers (PBMs)

Beyond the Middleman: The PBM Market at an Inflection Point

The Pharmacy Benefit Manager (PBM) market is at a tipping point. Long-standing structural issues are now translating into real dissatisfaction, sharper scrutiny, and market share shifts away from traditional models. Several trends are driving this shift at once: rapidly rising pharmacy spend, growing fiduciary and regulatory pressure, and increasing demand from plan sponsors for better […]

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Mapping the Vertical Integration of Insurers, PBMs, GPOs, Specialty Pharmacies, and Healthcare Services

It’s time for Drug Channels Institute’s (DCI) annual update of vertical integration among insurers, PBMs, specialty pharmacies, and healthcare services within U.S. drug channels. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical integration strategies. Scrutiny of these companies’ actions continues

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A Landmark Shift in Healthcare: 3 Insights from NHE and Drug Topics’ Webinar on PBM Reform

New laws and court decisions, settlements with the Federal Trade Commission, and a proposed Department of Labor rule are leading to a sweeping transformation that is already under way in the U.S. healthcare system. Pharmacy benefit managers (PBMs) are now facing the same transparency and accountability requirements that employers and health plans are subject to.

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The Top Pharmacy Benefit Managers of 2025: Market Share and Key Industry Developments

Three is still the magic number for pharmacy benefit managers (PBMs). For 2025, 80% of all equivalent prescription claims were processed by three companies: the CVS Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group. Express Scripts continued to pull ahead of its peers, while

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