The PBM Monopoly: Why Three Companies Control Your Prescription Drug Costs

Three pharmacy benefit managers control nearly 80% of all prescription drugs. This market concentration drives up costs while these companies enjoy explosive profit growth at the expense of employers and employees.

The Numbers Behind the Monopoly

The top three PBMs processed 6.6 billion prescriptions in 2023, that's an enormous volume that translates directly into market control. These companies have experienced explosive revenue growth, jumping from approximately $400 billion to $600 billion, an increase that demonstrates just how profitable this monopolistic position has become.

The most concerning aspect of this growth centers on specialty drug pricing. While specialty medications serve only 1-2% of members, they represent around 45% of total health plan spending. This is where these PBMs extract maximum profits, and the disproportionate growth in this category shows they're capitalizing on this opportunity aggressively.

Why Nothing Will Change Without Action

These companies are profiting because they can, and nobody's stopping them. Their market position allows them to maintain high prices while claiming to provide cost savings. If you think this system will change voluntarily and these companies will give up this revenue stream, you're mistaken.

Drug costs aren't going down under the current system. This is a major issue for employers and families, creating significant financial strain that demands immediate attention.

The Real Solution: Choose a Different Path

Employers don't have to accept this monopolistic control. We offer a fundamentally different approach:

• 100% rebate pass-through with no hidden retention

• Complete pricing visibility so you know exactly what you're paying

• Contractual obligation to act in your best interest

  
  

What Employers Can Do

The monopoly controlling 80% of prescriptions won't voluntarily surrender hundreds of billions in revenue. Change happens when employers stop accepting arrangements that enrich middlemen at their expense.

Drug costs aren't decreasing under the current system, and this creates serious concerns for employers and families alike. The solution starts with individual employer decisions to reject monopolistic practices.

Your Options: You don't have to accept monopolistic control over your pharmacy benefits. Fiduciary alternatives exist that eliminate conflicts of interest and deliver genuine savings.

The power to change this system rests in your hands. It starts with your next PBM decision.