A recent American Medical Association found that 72% of insured individuals are covered by companies owning or closely linked to a pharmacy benefit manager. As a result, the organization is advocating for stronger regulatory oversight.
The AMA's report, released Sept. 9, found that CVS Health, OptumRx, Express Scripts and Prime Therapeutics control 70% of the national PBM market, according to a news release shared with Becker's. The analysis also found that 82% of PBM markets at the regional level are highly concentrated, suggesting limited competition.
The AMA highlighted concerns over limited competition and high levels of vertical integration of PBMs with health insurance companies.