Who are the Six Largest PBMs?
Pharmacy Benefit Managers (PBMs) are third-party companies that manage prescription drug benefits for employers, health plans, and government programs. PBMs are responsible for negotiating discounts and rebates with drug manufacturers, managing drug formularies, and processing and paying prescription drug claims. With the rising cost of prescription drugs, PBMs have become increasingly important in helping to manage drug costs.
In this article, we will answer the question, “Who are the six largest PBMs?” We will also provide a more comprehensive understanding of the PBMs ranked by market share, as well as solutions and related topics.
PBMs Ranked by Market Share
According to a report from the National Association of Chain Drug Stores (NACDS), the six largest PBMs in the United States, ranked by market share, are:
CVS Caremark: 34 percent. Express Scripts: 24 percent. OptumRx (UnitedHealth): 21 percent. Humana Pharmacy Solutions: 8 percent. Prime Therapeutics: 6 percent. MedImpact Healthcare Systems: 5 percent. All other PBMs: 3 percent. 8 Mar 2022.
CVS Caremark is the largest PBM in the United States, with a market share of 34 percent. Express Scripts is the second largest PBM, with a market share of 24 percent. OptumRx (UnitedHealth) is the third largest PBM, with a market share of 21 percent. Humana Pharmacy Solutions is the fourth largest PBM, with a market share of 8 percent. Prime Therapeutics is the fifth largest PBM, with a market share of 6 percent. MedImpact Healthcare Systems is the sixth largest PBM, with a market share of 5 percent. All other PBMs have a market share of 3 percent.
Solutions
PBMs play an important role in helping to manage drug costs, and the six largest PBMs in the United States are CVS Caremark, Express Scripts, OptumRx (UnitedHealth), Humana Pharmacy Solutions, Prime Therapeutics, and MedImpact Healthcare Systems.
In order to reduce drug costs, PBMs use a variety of strategies, such as negotiating discounts and rebates with drug manufacturers, managing drug formularies, and processing and paying prescription drug claims. PBMs also use technology to help identify potential savings opportunities, such as generic substitution and therapeutic interchange.
PBMs also work with employers, health plans, and government programs to develop customized drug benefit plans that meet the needs of their members. These plans may include cost-sharing arrangements, such as copayments, coinsurance, and deductibles, as well as formulary management and utilization management programs.
Related Topics
What is a PBM?
A PBM is a third-party company that manages prescription drug benefits for employers, health plans, and government programs. PBMs are responsible for negotiating discounts and rebates with drug manufacturers, managing drug formularies, and processing and paying prescription drug claims.
What are the Benefits of Using a PBM?
The benefits of using a PBM include cost savings, improved patient outcomes, and increased access to medications. PBMs can help reduce drug costs by negotiating discounts and rebates with drug manufacturers, managing drug formularies, and processing and paying prescription drug claims. PBMs also use technology to help identify potential savings opportunities, such as generic substitution and therapeutic interchange.
What is a Formulary?
A formulary is a list of medications that a PBM or health plan will cover. PBMs use formularies to manage drug costs by encouraging the use of generic medications, preferred brands, and therapeutic alternatives. Formularies are typically divided into tiers, with the lowest tier containing the least expensive medications and the highest tier containing the most expensive medications.
Conclusion
In conclusion, PBMs play an important role in helping to manage drug costs. The six largest PBMs in the United States are CVS Caremark, Express Scripts, OptumRx (UnitedHealth), Humana Pharmacy Solutions, Prime Therapeutics, and MedImpact Healthcare Systems. PBMs use a variety of strategies to reduce drug costs, such as negotiating discounts and rebates with drug manufacturers, managing drug formularies, and processing and paying prescription drug claims. They also work with employers, health plans, and government programs to develop customized drug benefit plans that meet the needs of their members.
To learn more about PBMs and how they can help reduce drug costs, visit the National Association of Chain Drug Stores (NACDS) website here. For more information about formularies and how they can help manage drug costs, visit the Centers for Medicare & Medicaid Services (CMS) website here.
PBMs are an important part of the healthcare system, and understanding who the six largest PBMs are can help employers, health plans, and government programs manage drug costs and improve patient outcomes.