PHARMACIST STEVE

Has anyone noticed that PBMs are running TV commercials about how they can save everyone money on their prescriptions. What they don’t say is that while you MAY pay less out of pocket. Your insurance company may pay multiple times what it would cost them if you pay for your prescription and you send in a claim to get reimbursed.

Below is some information on how opaque the insurance/PBM industry’s financial disclosures are, and all of these companies are publicly traded companies.

Over the years, there have been several times when bureaucrats have tried to set up some sort of bureaucratic oversight mechanism to on the PBMs, and every time the PBMs industry brings out its “dog & pony show” about how much more pts will end up paying for their prescriptions if the PBM industry has some bureaucratic oversight and regulations that if the PBM industry was not able to control the prices of prescriptions, all the community pharmacies would jack-up their prices and they would make some profits that the PBM industry would loose.

Who would imagine that inserting numerous middlemen into our Rx distribution system? Each with their own operating overhead and interest in generating a net profit, and they could save EVERYONE some money. Apparently, the majority of bureaucrats and many at the top of many large corporations believed the PBMs “dog & pony show”.

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Let me search for specific information about mail-order pharmacy revenues and profits for the major PBMs.Let me search for more specific information about mail-order pharmacy revenues and profits.Based on my searches, I can provide some general information about mail-order pharmacy revenues, though specific profit breakdowns by mail-order operations are not typically disclosed separately by the major PBMs.

Mail-Order Pharmacy Market Overview:

Market Size and Growth:

• The Global Mail Order Pharmacy Market is estimated to be valued at USD 144.72 Bn in 2025 and is expected to reach USD 439.58 Bn by 2032, exhibiting a compound annual growth rate (CAGR) of 17.2%

Key Players in Mail-Order:

The same “Big Three” PBMs that dominate the overall market also control most mail-order pharmacy operations:

1. CVS Caremark – Operates CVS mail-order pharmacies
2. Express Scripts – Operates Express Scripts Pharmacy mail-order services
3. OptumRx – Operates OptumRx mail-order pharmacy services

Financial Context:

While specific mail-order profit margins aren’t typically disclosed separately, we know that:

• Pharmacy benefit managers CVS Caremark, OptumRx and Express Scripts inflated costs for specialty generic drugs to treat diseases such as cancer and HIV to the tune of $7.3 billion over six years
• Mail-order pharmacies are particularly profitable for PBMs because they:
  • Allow for bulk purchasing and dispensing
  • Reduce overhead costs compared to retail locations
  • Enable better inventory management
  • Often handle specialty and high-cost medications
  • Generate higher profit margins through direct-to-consumer delivery

Limitations in Available Data:

The challenge with providing exact mail-order specific revenue and profit figures is that:

1. Integrated Operations: Mail-order pharmacy operations are typically integrated into the broader PBM business and not reported as separate line items
2. Private Financial Data: Specific profit margins for mail-order operations are considered proprietary business information
3. Complex Revenue Streams: PBMs generate revenue through multiple channels (rebates, dispensing fees, spread pricing, administrative fees) that aren’t easily separated by delivery method

The mail-order pharmacy segment represents a significant and rapidly growing portion of the overall PBM business, with the market expected to triple in size over the next 7-8 years, but specific revenue and profit breakdowns for this segment remain closely guarded by the major PBMs.

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I’ll search for current information about the top 5 Pharmacy Benefit Managers (PBMs) and their financial performance.Let me search for more specific financial data on the major PBM companies.Based on the search results, I can provide information about the top PBMs and their financial scale, though specific profit breakdowns by PBM division are not always separately reported since these are parts of larger healthcare conglomerates.

Top 5 PBMs by Market Share and Revenue Scale:

The “Big Three” that dominate ~80% of the market:

1. CVS Caremark (CVS Health) – Part of CVS Health’s overall operations
2. Express Scripts (Cigna) – Part of Cigna’s Evernorth division
3. OptumRx (UnitedHealth Group) – Part of UnitedHealth’s Optum division

Additional major players: 4. Humana Pharmacy Solutions/CenterWell 5. MedImpact Healthcare Systems (largest privately-held PBM)

Financial Scale:

UnitedHealth Group (includes OptumRx):

• 2024 revenues hit $400.3 billion – a 6% year-over-year increase – and full-year earnings from operations were $32.3 billion
• UnitedHealth Group reported $5.5 billion in profit for the fourth quarter of 2024

Overall PBM Market:

• The three largest PBMs make up about 80% of the market share covering about 270 million people with a market of almost $600 billion in 2024

Key Context:

• From 2017 to 2022, the companies — UnitedHealth Group’s Optum, CVS Health’s CVS Caremark and Cigna’s Express Scripts — marked up prices at their pharmacies by hundreds or thousands of percent, netting them $7.3 billion in revenue in excess of the acquisition costs of the drugs

The challenge with providing exact PBM-specific revenue and profit figures is that these businesses are integrated into much larger healthcare companies. The total addressable market for PBMs is approaching $600 billion annually, with the top three controlling about 80% of that market. However, the parent companies (CVS Health, Cigna, UnitedHealth) don’t always break out PBM-specific profit margins in their public filings, as these operations are strategically integrated with their insurance and healthcare delivery businesses.

Filed under: General Problems