A paper by Qato et al. (2024) quantifies the diploma of of pharmacy profit supervisor (PBM) market focus.
Throughout all payer varieties, the PBM market was extremely concentrated, with an HHI [Herfindahl Hirschman Index (HHI)] of 1972…the HHI was lowest in business insurance coverage (1940), with 90 PBM individuals, and highest in Medicare Half D (2399), with 21 PBM individuals.
Three PBMs dominate in most all markets. In reality, these three giant PBMs (CVS Caremark, Optum Rx, and Categorical Scripts) account for 73.6% of retail prescriptions stuffed. This does fluctuate by payer kind.
…CVS Caremark alone accounted for 39.2% of PBM providers within the Medicaid managed care market, 28.5% in business markets, and 33.4% in Medicare Half D, whereas Categorical Scripts accounted for 28.0% of the business market, roughly twice its share in Medicaid (12.3%) and Medicare Half D (15.4%). Optum Rx and SS&C Well being accounted for a higher share of the Medicare Half D market (27.7% and 16.2%, respectively) in contrast with business (16.4% and a pair of.9%) or Medicaid (15.8% and 1.2%) markets.
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