Cigna’s Express Scripts has emerged as the largest pharmacy benefit manager in the U.S. by market share, overtaking long-time leader CVS Caremark, according to a March 31 report from the Drug Channels Institute.
In 2024, Express Scripts handled 30% of all prescription claims, up significantly from 23% in 2023. Meanwhile, CVS Health’s CVS Caremark saw its share decline from 34% to 27% over the same period. Express Scripts’ growth was largely driven by a major contract win to manage pharmacy benefits for 20 million Centene members, previously served by CVS Caremark.
Together with UnitedHealth Group’s Optum Rx, which processed 23% of claims, the three largest PBMs accounted for 80% of the total U.S. prescription claims market in 2024 — a one percentage point increase from 2023.
The rankings are based on the Drug Channels Institute’s analysis of total equivalent prescription claims managed across the PBM industry in 2024.
The top PBMs by 2024 market share:
Express Scripts: 30%
CVS Caremark: 27%
Optum Rx (UnitedHealth): 23%
Humana Pharmacy Solutions: 7%
MedImpact Healthcare Systems: 5%
Prime Therapeutics: 3%
All other PBMs and cash pay: 5%
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