Brookings March 24, 2023
Richard G. Frank, Conrad Milhaupt

INTRODUCTION AND BACKGROUND

The health care sector has become increasingly vertically integrated in recent years. The initial waves of integration largely involved mergers and acquisitions between hospitals and physician practices. More recently, the parent companies of large health insurers have been acquiring pharmacy benefit managers (PBMs), specialty pharmacies, physician practices, and other related health care businesses.

Research Analyst – USC-Brookings Schaeffer Initiative for Health Policy

In 2015, the three largest PBMs in the country (Express Scripts, CVS Caremark, and OptumRx) managed the drug benefits of 78% of the population. Following the Cigna acquisition of Express Scripts and the CVS/Aetna merger in late 2018, each of these PBMs is now part of...

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