A new analysis from the American Medical Association (AMA) adds to the growing evidence detailing the lack of competition and high vertical integration in the pharmacy benefit manager market.

The paper is based on 2022 and 2023 data on prescription drug plan enrollees and comes shortly after the Federal Trade Commission and the U.S. House Committee on Oversight and Accountability released similar reports on PBMs.

The AMA found that OptumRx was the largest PBM in the U.S. in 2023 with a 22.2% share in the rebate negotiation market, followed by CVS Caremark with an 18.9% market share, Express Scripts with a 15.5% market share and Prime Therapeutics with a 10.6% market share. Together, these four PBMs had a 67% share of the national PBM market in 2023.

There was also serious vertical int

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