U.S. prescription market: market share of pharmacy benefit managers 2018

In 2018, the top pharmacy benefit managers included CVS Health, Express Scripts, and OptumRx, to name a few. CVS Health had the largest share of the pharmacy benefit manager market in 2018. In total CVS Health held 30 percent of the market at that time. Pharmacy benefit managers are an important part of the prescription drug supply chain.

Pharmacy benefit managers

Pharmacy benefit managers are responsible for the operation and distribution of pharmaceuticals to patients and pharmacies. They are also responsible for the negotiation of rebates and processing of insurance claims from patients and pharmacies. Among pharmaceutical distributors in the U.S., chain stores distributed the larges value of pharmaceuticals in recent years. However, data suggests that pharmacy benefit managers have the highest gross profit among all actors in the U.S. drugs supply chain.

Generic drugs

In recent years, the growth of the generic prescriptions volume in the U.S. market has remained fairly stable with growth in all years. With stable growth in generics, the number of brand name medicines that were excluded from pharmacy benefit manager formularies in recent years had been on the rise. Generic drugs are useful to the consumer in that, in many cases, they provide a cheaper (but equal) alternative to brand name drugs.

Market share of the top 5 pharmacy benefit managers in the U.S. prescription market in 2018

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Source

Release date

March 2019

Region

United States

Survey time period

2018

Supplementary notes

Market share based on total prescription claims.
* Includes pro forma combination of claims processed by Aetna. Excludes double counting of network claims for mail choice claims filled at CVS retain pharmacies.
** Includes Anthem. During 2019, Anthem claims will be transitioning to IngenioRx.
***Includes Cigna. By the end of 2020, Cigna claims will transition to Express Scripts.
**** Figure includes some cash pay prescriptions that use a discount card processed by one of the 6 PBMs shown on the chart.

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Statistics on "U.S. pharmaceutical industry"

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