AMA study: Pharmacy benefit manager market highly concentrated, integrated with insurers

Oct 13, 2022 - 09:33 PM
Prescription Drug Pricing. Green and white capsules on a pharmacy counter.

The market for pharmacy benefit manager services is highly concentrated, with commercial insurers often sharing ownership in the PBM, according to an analysis released today by the American Medical Association. Based on 2020 data from the commercial insurance market, the study found the 10 largest PBMs share 97% of the market for the three PBM services most used by insurers: negotiating rebates with drug makers, assembling retail pharmacy networks, and administering and processing pharmacy claims.
 
“The American Medical Association already has serious concerns about PBM business practices that can have a detrimental impact on patients’ access to and cost of prescription drugs,” said AMA President Jack Resneck Jr, M.D. “PBM markets require careful scrutiny as less competition and more vertical integration can embolden anti-competitive business practices to the detriment of patients.”
 
AHA has urged the Federal Trade Commission to scrutinize commercial health plans that steer patients to third-party specialty pharmacies in which they have a financial interest, preventing health care providers from procuring and managing the drugs they administer to patients.

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