Last week, the Federal Trade Commission (FTC) released a report titled “Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies.” While I won’t get into an analysis of the specific arguments FTC made, the report does have a number of interesting statistics and graphics on pharmacy benefit managers (PBMs). Some highlights are below.

First, PBMs do much more than just design formularies. Now they are highly integrated entities, with many large PBMs being owned directly by health plans.

PBM size increased due to a series of consolidations over the past 25 years.

The market share of the 3 largest PBMs (CVS Caremark, Express Scripts (ESI), and OptumRx) increased from 70% to 79% of the PBM market.

Specialty mail order pharmacy is increasing as a share or PBM revenue relative to other channels.

In fact, PBM parent companies’ revenue comprised 22% of all US national health expenditure as of 2023.

You can read the full report here.