A brand new evaluation from the American Medical Affiliation (AMA) provides to the rising proof detailing the dearth of competitors and excessive vertical integration within the pharmacy profit supervisor market.
The paper is predicated on 2022 and 2023 information on prescription drug plan enrollees and comes shortly after the Federal Commerce Fee and the U.S. Home Committee on Oversight and Accountability launched comparable experiences on PBMs.
The AMA discovered that OptumRx was the most important PBM within the U.S. in 2023 with a 22.2% share within the rebate negotiation market, adopted by CVS Caremark with an 18.9% market share, Categorical Scripts with a 15.5% market share and Prime Therapeutics with a ten.6% market share. Collectively, these 4 PBMs had a 67% share of the nationwide PBM market in 2023.
There was additionally critical vertical integration of insurers with PBMs in 2023, with 77% of business and Half D enrollees in a prescription drug plan the place the insurer and PBM had been vertically built-in, in accordance with the AMA. When simply Half D prescription drug plan lives, 88% had been in a plan the place there was vertical integration, in comparison with 71% in business.
As well as, 9 of the ten largest PBMs share possession with well being insurers. This consists of OptumRx (owned by UnitedHealth Group), CVS Caremark (owned by CVS Well being) and Categorical Scripts (owned by Cigna).
UnitedHealth Group was the most important prescription drug plan insurer within the business market and the Medicare Benefit market, with a 13.2% share and 29.4% share, respectively. CVS Well being, in the meantime, was the most important prescription drug plan insurer within the standalone market with a 27.2% share, in accordance with the AMA.
“As PBMs more and more act in their very own self-interest with out transparency or accountability, drug costs rise and sufferers face well being dangers from value prohibitive drug remedies,” stated AMA President Bobby Mukkamala, M.D., in a press release. “The AMA’s evaluation is meant to offer perception to assist policymakers perceive the anticompetitive circumstances within the PBM market that can lead to hurt to sufferers.”
Mukkamala added that the AMA helps initiatives aimed toward rising transparency and holding pharmacy profit managers accountable.
On the federal stage, a number of bipartisan payments have been launched concentrating on PBMs. This consists of the PBM Reform Act launched by Rep. Earl L. “Buddy” Carter (R-Georgia) in July, which seeks to ban unfold pricing in Medicaid. There’s additionally the Sufferers Earlier than Monopolies Act, launched in December by Senators Elizabeth Warren (D-Massachusetts) and Josh Hawley (R-Missouri), which might ban PBMs from proudly owning pharmacies.
Picture: z_wei, Getty Photographs
