The AMA published its annual analysis of PBM market competition on Sept. 9. The report found CVS Caremark is the largest PBM by market share, followed by UnitedHealth’s Optum Rx.
Elevance Health, Humana and Centene had a much smaller market share than CVS, Optum, Cigna’s Express Scripts and Prime Therapeutics. Data in the report is from 2022.
Here’s how payers PBMs stack up on market share, according to the AMA:
- CVS Caremark
Rebate negotiation: 21.3%
Retail network management: 21.4%
Claims adjudication: 19.9% - Optum Rx (UnitedHealth Group)
Rebate negotiation: 20.8%
Retail network management: 21.3%
Claims adjudication: 21.1% - Express Scripts (Cigna)
Rebate negotiation: 17.1%
Retail network management: 17.1%
Claims adjudication: 17.1% - Prime Therapeutics (Blue Cross Blue Shield)
Rebate negotiation: 10.3%
Retail network management: 10.3%
Claims adjudication: 9.5% - Kaiser Pharmacy
Rebate negotiation: 8.6%
Retail network management: 8.6%
Claims adjudication: 8.6% - IngenioRx (Elevance Health)
Rebate negotiation: 8.0%
Retail network management: 8.0%
Claims adjudication: 8.0% - Humana Pharmacy Solutions
Rebate negotiation: 6.8%
Retail network management: 6.8%
Claims adjudication: 6.8% - Centene
Rebate negotiation: 1.8%
Retail network management: 1.8%
Claims adjudication: 1.4%
Read the full report here.
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