Who is my pharmacy benefit manager?
Asked by: Dr. Ervin Satterfield Sr. | Last update: June 28, 2025Score: 4.6/5 (62 votes)
Is CVS Caremark a pharmacy benefit manager?
The impact of pharmacy benefit managers (PBMs)
As part of CVS Health®, CVS Caremark® plays a critical role in the health care system by negotiating low net costs for our customers while supporting safe and clinically effective products for consumers.
Who are the big 3 pharmacy benefit managers?
Regarding the 3 major pharmacy benefit managers (PBMs) significantly controlling the US drug supply chain—CVS Caremark, Express Scripts, and Optum Rx—their concentration varied noticeably amongst commercial insurance, Medicare Part D, and Medicaid managed care markets.
Is OptumRx a pharmacy benefit manager?
OptumRx acts as the Pharmacy Benefit Manager for most of CalPERS health plans. The following health plans feature OptumRx: Anthem Blue Cross, Traditional & Select HMO.
What is an example of a PBM?
As of 2023, PBMs managed pharmacy benefits for 275 million Americans and the three largest PBMs in the US, CVS Caremark, Cigna Express Scripts, and UnitedHealth Group's Optum Rx, make up about 80% of the market share covering about 270 million people with a market of almost $600 billion in 2024.
How pharmacy benefit managers influence drug pricing
Is GoodRx a pharmacy benefit manager?
GoodRx contracts with Pharmacy Benefit Managers (“PBMs”), which are companies that manage prescription drug benefits, to offer its users access to PBM pricing.
What is the most common PBM?
- The four largest PBMs collectively have a 70% share of the national PBM market.
- CVS Health is the largest PBM (21.3% market share), followed by OptumRx (20.8%), Express Scripts (17.1%), and Prime Therapeutics (10.3%).
What is my pharmacy benefit manager?
Pharmacy benefit manager: A middleman entity that contracts with health insurance plans to develop and administer pharmacy benefits, including negotiating with drug manufacturers to develop the plan's formulary and negotiating with pharmacies to develop the plan's pharmacy network.
What is the phone number for OptumRx pharmacy benefit manager?
For general information about your pharmacy benefits including coverage and cost questions, please call 1-866-208-5184 or the number on the back of your card.
What PBM is owned by CVS?
1 CVS Caremark, the PBM for CVS, is the second largest PBM in the U.S., accounting for nearly 33% of covered lives.
Does Walgreens have a PBM?
Walgreens Boots Alliance has officially launched its new specialty pharmacy and prescription mail services company with pharmacy benefit manager Prime Therapeutics, a PBM owned by 14 Blue Cross and Blue Shield plans.
How does a PBM make money?
Pharmacy Benefit Managers earn profits primarily through administrative fees charged for their services, through spread pricing (the difference between what is paid to pharmacies and the negotiated payment from health plans), and shared savings where the PBM keeps part of the rebates or discounts negotiated with drug ...
What is the problem with PBMs?
While pro-consumer in theory, the lack of transparency and inability of plan sponsors to assess how much PBMs generate in savings and how much they retain for themselves is the root issue, with plan sponsors and others having little to no ability to monitor PBM behavior.
What companies are pharmacy benefit managers?
- Aetna Health of California, Inc.
- Blue Cross of California (Anthem Blue Cross)
- Blue Shield of California Promise Health Plan.
- California Physicians' Service (Blue Shield of California)
- Molina Healthcare, Inc.
- Oscar Healthcare of California.
- Sharp Health Plan.
- Sutter Health Alliance (Sutter Health Plan)
Is Express Scripts a pharmacy benefit manager?
An organization that manages the pharmacy portion of health plan coverage to make sure the use of medicine is safer and more affordable. Express Scripts is a PBM and a member of the national association of PBMs, the Pharmaceutical Care Management Association.
Is rx benefits the same as Caremark?
RxBenefits is your Pharmacy Benefit Administrator (PBA). We partner with the country's largest Pharmacy Benefit Managers (PBM) to bring greater discounts, enhanced access, and improved Member Services to our clients and their employees. Your pharmacy benefits coverage will be with CVS Caremark.
Is Caremark a PBM?
As a pharmacy benefit manager (PBM), we play a critical role in the health care system by negotiating a low net cost for our customers and facilitating access to affordable medications that people need to stay healthy.
Can I use CVS Pharmacy with OptumRx?
OptumRx® and CVS Pharmacy® make it easy for you to get your maintenance medications and may save you money. 1 The OptumRx CVS90 Saver program allows you to get 90-day supplies of your maintenance medications at nearly 9,700 CVS Pharmacy locations or through OptumRx home delivery — the choice is yours.
Is OptumRx a pharmacy benefit manager?
As a pharmacy benefit manager (PBM), our goal is to improve the affordability of health care and prescription drugs for both plan sponsors and members. This is a modal window.
Who is the big 3 pharmacy benefit manager?
CVS Caremark, Express Scripts and OptumRx dramatically mark up specialty generic drugs to affiliated pharmacies, the Federal Trade Commission (FTC) uncovered in its second interim staff report released Jan.
Is Caremark the same as CVS?
2007: CVS acquires Caremark, giving birth to the nation's leading pharmacy-benefits manager. 2014-2015: CVS acquires Coram, Omnicare , Navarro Discount Pharmacy and all of Target's 1,600 pharmacies and clinics.
What is an example of a pharmacy benefit manager?
Currently the three largest PBMs - CVS Caremark, Express Scripts and OptumRx (a division of United Healthcare) hold nearly 80% of the prescription benefits market in the U.S.
What is my PBM?
Pharmacy benefits managers are third-party administrators of prescription drug programs who contract with employers, insurers and pharmacies to manage prescription drug coverage for pharmacy patients.
Who owns pharmacy benefit managers?
The largest insurers (including Aetna, Cigna, Elevance, Humana, United Healthcare, and many non-profit Blue Cross Blue Shield plans) generally own PBMs or are part of companies that own PBMs.
What is a PBM often called?
The principal services offered by pharmacy benefit management companies (PBMs) are described. A PBM contracts with employers, insurers, and others to provide accessible and cost-effective benefits to those groups' members.