4sight Health September 18, 2024
The collars of healthcare trade association executives must be getting a little tight right now as costs continue to rise and outcomes continue to slip. Someone has to take blame whether deserved or not.
On Sept. 9, the American Medical Association (AMA) blamed pharmacy benefit managers (PBMs) and commercial health insurance companies in a 20-page report titled, “Competition in PBM Markets and Vertical Integration of Insurers With PBMs.”
The report said four PBMs control 70% of the national PBM market when it comes to three core PBM functions: rebate negotiation, retail network management and claims adjudication. The four PBMs in ranked order are CVS Health, OptumRx, Express Scripts and Prime Therapeutics.
The report also said health insurers that are vertically...
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