PBM Market Share

I was looking for something the other day and stumbled upon this survey from earlier this year. I modified it to add the Wellpoint NextRx lives to the Express Scripts lives, but I wasn’t sure how to reconcile the Walgreens numbers (they are listed twice) and didn’t see any lives for RxAmerica which is now part of CVS Caremark.

Company

Rx Covered Lives

Market Share

Express Scripts / CuraScript / Wellpoint NextRx

90,049,000

13.20%

CVS/Caremark Rx, Inc.

82,000,000

12.02%

Walgreens-OptionCare

75,000,000

10.99%

ICORE Healthcare, Inc.

60,000,000

8.79%

Medco Health Solutions, Inc.

60,000,000

8.79%

NovoLogix (formerly Ancillary Care Management)

40,000,000

5.86%

Argus Health Systems, Inc.

28,600,000

4.19%

MedImpact Healthcare Systems, Inc.

27,000,000

3.96%

HealthTrans

15,300,000

2.24%

Prime Therapeutics, LLC

14,700,000

2.15%

 

The other thing to note here that we always joke about is how 70% of the market is equal to almost 500M lives (more than the US population). It has to do with people who have mail with one PBM, specialty with another PBM, and claims processing with another PBM (for example).

It is an interesting space right now. Two of the top 10 PBMs are actively looking for a CEO/President – CVS Caremark and Prime Therapeutics. You have seen lots of press releases recently from companies like Express Scripts, Medco, and CVS Caremark on new partnerships and technologies that they are working with. I also think you’ve seen a shift in research from Express Scripts to Medco which has been publishing a lot more recently. And, you’ve also seen several Medco alumni go to CVS Caremark at very senior positions.

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