Drug Channels Institute has released its annual pharmacy and PBM market outlook, detailing how retail dynamics, payer influence and vertical integration are shaping the $500 billion U.S. prescription drug ecosystem.
Here are five key trends from the “2026 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers”:
1. Retail dominates prescription fills.
More than 2 billion prescriptions were filled in 2025, with retail chains accounting for more than 40% and independent pharmacies just 17%.
2. PBMs control 90% of pharmacy claims.
Ten pharmacy benefit managers — led by CVS Caremark, Express Scripts and OptumRx — manage more than 90% of total claims volume.
3. PBMs serve more than 275 million Americans.
PBMs function as intermediaries between payers, pharmacies and manufacturers for more than 275 million patients.
4. Market consolidation continues.
Vertical integration across payers, PBMs and retail chains is concentrating influence over access, pricing and drug delivery.
5. Independent pharmacies face mounting pressure.
The share of prescriptions filled by independent pharmacies continues to shrink as systems and networks expand around larger entities.
The full report includes data visualizations and network maps that illustrate payer-PBM relationships, pharmacy density and ownership overlap across the supply chain.
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