The future of pharmacy benefits: The shift to insourcing PBM services

Healthcare DIVE March 24, 2025

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The growing demand for PBM insourcing

For decades, the three largest PBMs have dominated the market, controlling 70% of pharmacy benefits nationwide. Yet, dissatisfaction with their services has reached a decade-long high. A 2023 survey by Pharmaceutical Strategies Group revealed that organizations are increasingly frustrated with a lack of flexibility, limited transparency and misaligned incentives.

Organizations—including health systems, health plans, large employers, and grocers—seek a tailored pharmacy benefit solution that offers greater control, flexibility and transparency. Rather than relying on legacy PBMs with misaligned incentives and varying strategies, they are turning to insourcing their pharmacy benefits as a strategic alternative.

“The primary reason for the shift away from the big three PBMs to new alternatives is...

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