According to a new analysis from the American Medical Association, the four largest pharmacy benefit managers (PBMs) now control 75% of the national market in 2024, up from 70% two years earlier.
The study drew on prescription drug plan and enrollment data for 2022 and 2024, evaluating the market positions of the ten largest PBMs.
In 2024, the leading PBMs by national market share were OptumRx (23%), Express Scripts (23%), CVS Caremark (18%) and Prime Therapeutics (11%). In 2022, the lineup was CVS (21%), OptumRx (21%), Express Scripts (17%) and Prime Therapeutics (10%). Express Scripts recorded the biggest gain between the two years.
The analysis further revealed that 32 PBM markets—representing 94% of the total—were highly concentrated in 2024, compared with 28 markets (82%) in 2022.
All ten of the listed PBMs have ownership ties to health insurers. In 2024, 69% of enrollees with commercial or Medicare Part D drug coverage were in plans offered by insurers that are vertically integrated with a PBM. The degree of integration differed markedly among local markets.
The report also looked at the national market shares of the ten largest insurers that offer prescription drug benefits. UnitedHealth Group held the largest share in commercial and Medicare Advantage PDP plans, while Centene led the stand‑alone Medicare Part D segment. Kaiser ranked second in the commercial market, Humana in Medicare Advantage PDP, and CVS Health (Aetna) was second in the stand‑alone market.
“Competitive PBM and prescription drug plan markets help patients get the medications they need at a fair price,” said AMA President Dr. Willie Underwood III. “But our analysis shows that a small number of PBMs account for a growing share of the market, while most local PBM markets remain highly concentrated and most prescription drug benefits are managed by vertically integrated insurers and PBMs.”
Photo: J Studios, Getty Images
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