A new analysis of the American Medical Association (AMA) adds to the growing evidence detailing the lack of competition and high vertical integration in the pharmacy benefit managers market.
The document is based on the data of 2022 and 2023 on the affiliates of the prescription drug plan and occurs shortly after the Federal Commerce Commission and the Supervision and Responsibility Committee of the US House of Representatives. UU. Published by similar reports on PBM.
The AMA discovered that Optumrx was the largest PBM in the US. In 2023 with a 22.2%share in the reimbursement negotiation market, followed by CVS Caremark with a market share of 18.9%, expresses scripts with a market share of 15.5%. Together, these four PBMs had a 67% share in the national PBM market in 2023.
There was also a serious vertical integration of insurers with PBM in 2023, with 77% of commercial affiliates and part D in a prescription drug plan where the insurer and PBM were integrated vertically, according to the AMA. When observing only the prescription drug plan lives on part D, 88% were in a plan in which there was vertical integration, compared to 71% in commercial.
In addition, nine of the 10 largest PBs share the property with health insurers. This includes Optumrx (owned by UnitedHealth Group), CVS Caremark (Property of CVS Health) and Express Script (CIGNA Property).
UnitedHealth Group was the largest insurer of prescription medications in the commercial market and the Medicare Advantage market, with a 13.2% and 29.4% participation share, respectively. CVS Health, meanwhile, was the insurer of the largest prescription drug plan in the independent market with a 27.2%participation, according to the AMA.
“As PBMs act more and more in their own interest without transparency or responsibility, medicines prices increase and patients face health risks of the treatments of costs of cost prohibition,” said Ama president, Bobby Mukkamala, MD, in a statement. “The AMA analysis is intended to provide information to help policy formulators understand the anti -competitive conditions in the PBM market that can cause damage to patients.”
Mukkamala added that the AMA supports initiatives aimed at increasing transparency and holding the pharmacy benefits managers.
At the federal level, several bipartisan bills aimed at PBMS have been introduced. This includes the PBM Reform Law introduced by the representative Earl L. “Buddy” Carter (R-Georgia) in July, which seeks to prohibit propagated prices in Medicaid. There is also patients before the Monopoly Law, introduced in December by Senators Elizabeth Warren (D-Massachusetts) and Josh Hawley (R-Missouri), which would prohibit PBMS to own pharmacies.
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