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Three companies controlled 79% of U.S. pharmacy benefit management in 2022, according to the data platform Statista: CVS Caremark with 33%, Express Scripts at 24%, and OptumRx owns 22% of the market.
July 9, 2024 at 6:28 PM. An ongoing Federal Trade Commission study finds pharmacy benefit managers may have inflated drug costs while squeezing independent pharmacies, enriching some of the ...
Pharmacy benefit management. In the United States, a pharmacy benefit manager ( PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
And in the most egregious cases, the parent company also owns a pharmacy chain, allowing a PBM to reimburse their own pharmacies for medications at a better rate than smaller, local pharmacies.
Express Scripts also offers pharmacy benefit management services for workers' compensation insurance programs. The program is accredited by URAC, the nation's largest accrediting body for pharmacy benefit management companies. The company processes pharmaceutical claims for members through a network of retail pharmacies.
Catamaran Corporation. Catamaran Corporation (formerly SXC Health Solutions) is the former name of a company that now operates within UnitedHealth Group's OptumRX division (since July 2015). It sells pharmacy benefit management and medical record keeping services to businesses in the United States [ 3] and to a broad client portfolio, including ...
Pharmacy benefit managers were created as a cost-saving measure for employers. A contracted manager could determine which medications would be covered by insurance and was then authorized to ...
Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals [ 1][ 2] classified as high-cost, [ 3][ 4][ 5] high complexity and/or high touch. [ 4] Specialty drugs are often biologics [ 3][ 6] —"drugs derived from living cells" [ 7] that are injectable or infused (although some are oral medications). [ 4]