Pharmacy Benefit Managers (PBMs)
The intermediaries that process prescription claims, manage formularies, and issue most prescription denials.
CVS Caremark is the largest US PBM. Manages prescription benefits for Aetna (sister company), many employer plans, and Medicare Part D plans (SilverScript).
Express Scripts is Cigna-owned. Operates Accredo specialty pharmacy. Major book of business in commercial + Medicare Part D.
Humana's in-house PBM. Heavily Medicare Advantage Part D focused.
Largest independent PBM (not owned by an insurer). Serves regional health plans + employer groups.
OptumRx is UnitedHealth Group's PBM. Manages prescription benefits for UnitedHealthcare members + many large employer + Medicare clients.
Prime Therapeutics is owned collectively by Blue Cross Blue Shield plans. Manages prescription benefits for member BCBS plans.
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