Senate hearing puts spotlight on debate over consolidation in PBM market

As officials from the big three pharmacy benefit manager giants testified on Capitol Hill on Tuesday, it was their sheer size that seemed to stick out most for senators. The three PBMs—Express Scripts, CVS Caremark and Optum—control the majority of the market, together totaling 71% of Medicaid membership and 86% of the private market, a sign of the ongoing consolidation in the industry. However, executives insisted at the hearing, the PBM space is a competitive one. “The consolidation in the industry is actually in an effort to, really, take better care of patients,” said Steve Miller, M.D., executive vice president and chief clinical officer for Cigna, the parent company of Express Scripts. He noted there are 60 PBMs operating nationally that offer varied regional options for private insurers, Medicaid and Medicare Part D to contract with. “We believe we can do an even better job of controlling cost.”