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They started as simple claims processors. Then, over three decades of mergers and shifts in business strategy, pharmacy benefit managers emerged as powerful conglomerates with the ability to extract billions of dollars in payments from the largest players in the nation’s drug supply chain.

And now, as their role in prescription drug pricing comes under increasing scrutiny, the nation’s biggest PBMs are changing shape again — this time by aligning themselves with the nation’s largest insurers.


Three PBMs control about 70 percent of the market in the U.S. And, if approved by authorities, all of them will soon be combined with insurance companies. OptumRx, the third-largest PBM, is already owned by UnitedHealthcare; deals to combine Express Scripts with Cigna and CVS Caremark with Aetna are now being considered by antitrust regulators. If they’re greenlighted, it will mark the end of the nation’s largest standalone PBMs.

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