Local PBM market is dwindling, AMA finds

Six pharmacy benefit managers account for 96 percent of the industry's market share, and their lead is growing, according to an analysis from the American Medical Association. 

The nation's largest PBMs — CVS Caremark, Express Scripts, OptumRx, Humana, Magellan Rx and MedImpact Healthcare Systems — already face little competition, but local PBMs are rapidly consolidating. 

Local PBMs are also becoming more concentrated, the report found. For example, at least 80 percent of state- and metropolitan-area level PBM markets were highly concentrated in 2021.

Federal agencies are currently probing the PBM industry, or the middlemen who negotiate drug prices between payers and pharmaceutical companies, and legislators have introduced federal bills aiming to limit PBM influence. 

The AMA's analysis found that insurers heavily rely on PBMs for three services: rebate negotiation, retail network management and claim adjudication. Access the analysis here.

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