Bipartisan Lawmakers Reintroduce Bill Barring PBMs from Owning Pharmacies
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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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Beyond the Middleman: The PBM Market at an Inflection Point
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Beyond the Middleman: The PBM Market at an Inflection Point Read More »
States’ Efforts to Rein in PBMs Hit a Legal Roadblock
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States’ Efforts to Rein in PBMs Hit a Legal Roadblock
State efforts to regulate pharmacy benefit managers are colliding with federal law, reviving a power struggle over who can police the companies that manage drug benefits for most Americans. The states are trying to rein in the middlemen that negotiate drug prices and pay pharmacies, but they’re running into a federal law that has the
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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
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.
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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