Healthcare Economist September 13, 2024
A paper by Qato et al. (2024) quantifies the degree of of pharmacy benefit manager (PBM) market concentration.
Across all payer types, the PBM market was highly concentrated, with an HHI [Herfindahl Hirschman Index (HHI)] of 1972…the HHI was lowest in commercial insurance (1940), with 90 PBM participants, and highest in Medicare Part D (2399), with 21 PBM participants.
Three PBMs dominate in most all markets. In fact, these three large PBMs (CVS Caremark, Optum Rx, and Express Scripts) account for 73.6% of retail prescriptions filled. This does vary...
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