GITNUXREPORT 2026

Pbm Industry Statistics

The PBM industry is massive and growing rapidly but faces increasing regulatory scrutiny.

Rajesh Patel

Team Lead & Senior Researcher with over 15 years of experience in market research and data analytics.

First published: Feb 13, 2026

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Statistic 1

In 2022, PBMs generated $47 billion in gross savings for clients via generics.

Statistic 2

Average generic price deflation through PBMs: 85% off brand list price in 2023.

Statistic 3

PBM rebate guarantees averaged 14.5% of brand drug spend in commercial plans 2022.

Statistic 4

Spread pricing in Medicaid PBMs yielded $1.2 billion profit in 2022 across states.

Statistic 5

PBM transparent pricing models saved employers 18% on Rx costs in 2023 pilots.

Statistic 6

Brand drug net prices after PBM rebates fell 22% for top 25 drugs in 2022.

Statistic 7

PBM formulary management saved $12 billion on specialty drugs in 2023.

Statistic 8

Average PBM DIR fees per Part D claim: $14.50 in 2022.

Statistic 9

PBMs negotiated $28 billion in biosimilar savings potential by 2025.

Statistic 10

Client savings from PBM mail-order: 32% lower cost per script in 2023.

Statistic 11

PBM pharmacy network reimbursements averaged $9.20 for generics in 2022.

Statistic 12

Rebate retention by PBMs: 25-35% of total $70 billion collected in 2023.

Statistic 13

PBM value-based pricing contracts covered 15% of specialty scripts, saving $3.5B in 2023.

Statistic 14

MAC pricing lists by PBMs reduced generic costs by 15% YoY in 2022.

Statistic 15

PBM copay accumulator programs increased client savings by $4 billion in 2023.

Statistic 16

Net cost of insulins after PBM rebates dropped 48% since 2017 to 2023.

Statistic 17

PBM group purchasing saved $18 billion on hospital drugs indirectly in 2022.

Statistic 18

Average brand rebate per claim: $52 in commercial PBM plans 2023.

Statistic 19

PBM price transparency laws reduced spreads by 40% in affected states 2023.

Statistic 20

Specialty tier cost-sharing via PBMs averaged $150 per script in 2022.

Statistic 21

PBMs clawed back $2.8 billion in pharmacy performance penalties in 2022.

Statistic 22

CVS Caremark holds 33% U.S. PBM market share based on lives covered in 2023.

Statistic 23

Express Scripts commanded 26% market share in commercial prescriptions filled in 2022.

Statistic 24

OptumRx captured 22% of the Medicare Part D market in 2023.

Statistic 25

The big three PBMs (CVS, Cigna, UNH) control 80% of U.S. prescription market as of 2023.

Statistic 26

Prime Therapeutics holds 8% market share in employer-sponsored plans in 2023.

Statistic 27

Humana Pharmacy Solutions has 5% share in Medicare Part D lives covered in 2023.

Statistic 28

Navitus Health Solutions grew to 3.2% market share among self-funded employers in 2023.

Statistic 29

MedImpact Healthcare Systems serves 16 million lives, 4% national share in 2023.

Statistic 30

CVS Caremark processed 1.6 billion prescriptions in 2022, leading the industry.

Statistic 31

Express Scripts filled 1.4 billion claims, holding 28% commercial share in 2023.

Statistic 32

OptumRx managed 1.1 billion prescriptions, 23% market share in 2022.

Statistic 33

J.S. LifeCare, Inc. has 1.5% share in Medicaid PBM contracts as of 2023.

Statistic 34

Magellan Rx Management controls 7% of Medicaid prescriptions in 2023.

Statistic 35

Top 10 PBMs cover 96% of covered lives under management in U.S. 2023.

Statistic 36

Cigna/Express Scripts grew market share to 27% in self-insured market 2023.

Statistic 37

UnitedHealth/OptumRx share in Fortune 500 plans reached 25% in 2023.

Statistic 38

Independent PBMs like SmithRx hold 2.1% share in transparent pricing segment 2023.

Statistic 39

PBM Coalition members represent 15% combined market share in 2023.

Statistic 40

CVS Health's PBM revenues were $153 billion in 2023, 34% industry total.

Statistic 41

Elevance Health (Anthem) PBM has 6% national share via IngenioRx in 2023.

Statistic 42

Centene Corp's PBM covers 12 million Medicaid lives, 9% state market avg.

Statistic 43

In 2023, the U.S. PBM industry processed approximately 4.8 billion adjusted prescription claims, accounting for 78% of all retail prescriptions filled in the country.

Statistic 44

The global PBM market was valued at $512.4 billion in 2022 and is projected to grow to $1,028.7 billion by 2030 at a CAGR of 9.1%.

Statistic 45

U.S. PBM revenues reached $614 billion in 2022, with rebates from drug manufacturers totaling $68 billion.

Statistic 46

The PBM sector's net revenue margins averaged 4.2% in 2022, up from 3.8% in 2021 due to higher generic dispensing rates.

Statistic 47

PBM-managed spending on prescription drugs in the U.S. hit $576.9 billion in 2022, a 8.4% YoY increase.

Statistic 48

By 2025, the PBM market is expected to capture 85% of U.S. employer-sponsored health plans.

Statistic 49

Specialty drug spending through PBMs rose to $237 billion in 2022, comprising 41% of total drug spend.

Statistic 50

PBM industry revenues from spread pricing generated $2.1 billion in Medicaid programs across 19 states in 2021.

Statistic 51

The PBM market in Europe is forecasted to reach €45 billion by 2027, growing at 6.5% CAGR from 2022.

Statistic 52

U.S. PBMs handled 82% of commercial prescriptions and 91% of Medicare Part D claims in 2023.

Statistic 53

Total PBM rebates passed through to clients were $45.6 billion in 2022, retaining 33% or $22.8 billion.

Statistic 54

PBM administrative fees averaged $11.50 per prescription in 2022 for commercial plans.

Statistic 55

The PBM industry's total addressable market for biosimilars is projected at $30 billion by 2026.

Statistic 56

In 2022, PBMs dispensed 15.2 billion 30-day equivalent prescriptions, with generics at 91.3% rate.

Statistic 57

PBM revenue from Medicare Part D was $180 billion in 2022, 31% of total industry revenue.

Statistic 58

Commercial PBM market revenues grew 10.2% to $285 billion in 2023 from prior year.

Statistic 59

PBMs captured 95% of Fortune 1000 employer prescription benefits in 2023.

Statistic 60

Global PBM outsourcing market size was $28.5 billion in 2023, expected to hit $42.3 billion by 2030.

Statistic 61

U.S. retail pharmacy revenues through PBM networks totaled $450 billion in 2022.

Statistic 62

PBM digital pharmacy revenues surged 25% to $12 billion in 2023.

Statistic 63

Medicaid PBM contracts generated $112 billion in drug spend managed in 2022.

Statistic 64

PBM industry EBITDA margins averaged 7.8% in 2022 for top three players.

Statistic 65

Projected U.S. PBM market growth rate of 7.8% CAGR from 2023-2030 to $950 billion.

Statistic 66

PBM rebates from specialty drugs reached $18.4 billion in 2022.

Statistic 67

Employer-sponsored PBM drug spend averaged $12,450 per employee in 2023.

Statistic 68

PBM-managed biosimilar uptake reached 45% market share in oncology by Q4 2023.

Statistic 69

Total PBM network pharmacies numbered 68,000 in the U.S. as of 2023.

Statistic 70

PBM revenues from patient assistance programs hit $5.2 billion in 2022.

Statistic 71

Asia-Pacific PBM market grew 12.3% to $15.6 billion in 2023.

Statistic 72

In 2022, PBMs adjudicated 5.2 billion retail prescriptions, with generics at 90.5%.

Statistic 73

Medicare Part D enrollment through PBMs reached 48 million beneficiaries in 2023.

Statistic 74

Average annual prescriptions per commercial member managed by PBMs: 14.8 in 2022.

Statistic 75

Specialty pharmacy claims via PBMs grew 18% to 120 million in 2023.

Statistic 76

Generic dispensing rate hit 92.1% for PBM-managed scripts in 2023.

Statistic 77

Mail-order pharmacy utilization through PBMs: 5.2% of total volume in 2022.

Statistic 78

PBM home delivery scripts increased 12% to 250 million in 2023.

Statistic 79

65% of PBM prescriptions were for chronic conditions in commercial plans 2022.

Statistic 80

Biosimilar scripts through PBMs: 2.5 million units in 2023, up 300% YoY.

Statistic 81

Retail scripts per PBM network pharmacy averaged 1.2 million annually in 2022.

Statistic 82

PBM prior authorization requests hit 45 million for commercial plans in 2023.

Statistic 83

28% of PBM-managed scripts were 90-day supplies in 2023.

Statistic 84

Oncology drug utilization via PBM specialty pharmacies: 8.4 million scripts in 2022.

Statistic 85

PBM compounded drug scripts surged 22% to 15 million in 2023.

Statistic 86

Average days supply for maintenance meds via PBMs: 78 days in 2023.

Statistic 87

PBM digital app fills reached 180 million prescriptions in 2023.

Statistic 88

Medicaid PBM scripts totaled 850 million, 16% of national volume in 2022.

Statistic 89

Step therapy overrides by PBMs: 12% of 35 million requests in 2023.

Statistic 90

GLP-1 agonist scripts via PBMs exploded to 28 million in 2023.

Statistic 91

PBM formulary exclusions impacted 4.2% of 4.9 billion scripts in 2023.

Statistic 92

FTC initiated antitrust probe into PBMs in 2022, focusing on rebate practices.

Statistic 93

15 states passed PBM transparency laws by end of 2023, mandating rebate pass-through.

Statistic 94

DOJ sued to block Ahold Delhaize's PBM acquisition in 2023 over competition concerns.

Statistic 95

CMS finalized rule reducing Part D DIR fees by 40% starting 2024 for PBMs.

Statistic 96

Ohio AG settled with Express Scripts for $46 million over spread pricing in 2023.

Statistic 97

Louisiana enacted law requiring 100% rebate pass-through by PBMs in Medicaid 2023.

Statistic 98

FTC reported PBMs retain $11.8 billion in Medicaid spread pricing profits 2017-2020.

Statistic 99

Texas passed HB 1805 mandating PBM spread pricing disclosure in 2023.

Statistic 100

Senate passed PBM Transparency Act (S. 2973) unanimously in 2022 for disclosure rules.

Statistic 101

Kentucky AG sued top PBMs for $400 million over insulin pricing in 2023.

Statistic 102

NAIC adopted model PBM regulation in 2023 requiring fiduciary duty standards.

Statistic 103

California AB 316 law bans spread pricing in Medi-Cal PBM contracts from 2024.

Statistic 104

HHS OIG audit found $4.7 billion in improper Part D payments tied to PBMs 2022.

Statistic 105

Arkansas enacted spread pricing ban for state employee plans in 2023.

Statistic 106

PBM Accountability Project filed 12 state lawsuits on rebate withholding by 2023.

Statistic 107

Inflation Reduction Act caps Part D premiums, impacting PBM negotiations from 2025.

Statistic 108

New York DFS probe into PBMs resulted in $1.5 million fine to Express Scripts 2023.

Statistic 109

28 states introduced 150+ PBM bills in 2023 legislative sessions.

Statistic 110

EU Commission investigated PBM-like intermediaries for rebate opacity in 2023.

Statistic 111

Oklahoma Insurance Dept approved fiduciary duty rule for PBMs in 2023.

1/111

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While the numbers are staggering—with the U.S. PBM industry processing nearly 5 billion prescriptions and the global market barreling toward a trillion dollars—the real story lies in the complex and often controversial mechanics behind these figures that affect every prescription filled and every healthcare dollar spent.

Key Takeaways

In 2023, the U.S. PBM industry processed approximately 4.8 billion adjusted prescription claims, accounting for 78% of all retail prescriptions filled in the country.
The global PBM market was valued at $512.4 billion in 2022 and is projected to grow to $1,028.7 billion by 2030 at a CAGR of 9.1%.
U.S. PBM revenues reached $614 billion in 2022, with rebates from drug manufacturers totaling $68 billion.
CVS Caremark holds 33% U.S. PBM market share based on lives covered in 2023.
Express Scripts commanded 26% market share in commercial prescriptions filled in 2022.
OptumRx captured 22% of the Medicare Part D market in 2023.
In 2022, PBMs adjudicated 5.2 billion retail prescriptions, with generics at 90.5%.
Medicare Part D enrollment through PBMs reached 48 million beneficiaries in 2023.
Average annual prescriptions per commercial member managed by PBMs: 14.8 in 2022.
In 2022, PBMs generated $47 billion in gross savings for clients via generics.
Average generic price deflation through PBMs: 85% off brand list price in 2023.
PBM rebate guarantees averaged 14.5% of brand drug spend in commercial plans 2022.
FTC initiated antitrust probe into PBMs in 2022, focusing on rebate practices.
15 states passed PBM transparency laws by end of 2023, mandating rebate pass-through.
DOJ sued to block Ahold Delhaize's PBM acquisition in 2023 over competition concerns.

The PBM industry is massive and growing rapidly but faces increasing regulatory scrutiny.

Cost Savings and Pricing

In 2022, PBMs generated $47 billion in gross savings for clients via generics.
Average generic price deflation through PBMs: 85% off brand list price in 2023.
PBM rebate guarantees averaged 14.5% of brand drug spend in commercial plans 2022.
Spread pricing in Medicaid PBMs yielded $1.2 billion profit in 2022 across states.
PBM transparent pricing models saved employers 18% on Rx costs in 2023 pilots.
Brand drug net prices after PBM rebates fell 22% for top 25 drugs in 2022.
PBM formulary management saved $12 billion on specialty drugs in 2023.
Average PBM DIR fees per Part D claim: $14.50 in 2022.
PBMs negotiated $28 billion in biosimilar savings potential by 2025.
Client savings from PBM mail-order: 32% lower cost per script in 2023.
PBM pharmacy network reimbursements averaged $9.20 for generics in 2022.
Rebate retention by PBMs: 25-35% of total $70 billion collected in 2023.
PBM value-based pricing contracts covered 15% of specialty scripts, saving $3.5B in 2023.
MAC pricing lists by PBMs reduced generic costs by 15% YoY in 2022.
PBM copay accumulator programs increased client savings by $4 billion in 2023.
Net cost of insulins after PBM rebates dropped 48% since 2017 to 2023.
PBM group purchasing saved $18 billion on hospital drugs indirectly in 2022.
Average brand rebate per claim: $52 in commercial PBM plans 2023.
PBM price transparency laws reduced spreads by 40% in affected states 2023.
Specialty tier cost-sharing via PBMs averaged $150 per script in 2022.
PBMs clawed back $2.8 billion in pharmacy performance penalties in 2022.

Cost Savings and Pricing Interpretation

While PBMs tout impressive client savings on generics and brand rebates, the industry's complex mechanics—from rebate retention and spread pricing to DIR fees and clawbacks—reveal a lucrative system where their own profits often grow alongside, or even from, the very costs they claim to be managing.

Market Share and Players

CVS Caremark holds 33% U.S. PBM market share based on lives covered in 2023.
Express Scripts commanded 26% market share in commercial prescriptions filled in 2022.
OptumRx captured 22% of the Medicare Part D market in 2023.
The big three PBMs (CVS, Cigna, UNH) control 80% of U.S. prescription market as of 2023.
Prime Therapeutics holds 8% market share in employer-sponsored plans in 2023.
Humana Pharmacy Solutions has 5% share in Medicare Part D lives covered in 2023.
Navitus Health Solutions grew to 3.2% market share among self-funded employers in 2023.
MedImpact Healthcare Systems serves 16 million lives, 4% national share in 2023.
CVS Caremark processed 1.6 billion prescriptions in 2022, leading the industry.
Express Scripts filled 1.4 billion claims, holding 28% commercial share in 2023.
OptumRx managed 1.1 billion prescriptions, 23% market share in 2022.
J.S. LifeCare, Inc. has 1.5% share in Medicaid PBM contracts as of 2023.
Magellan Rx Management controls 7% of Medicaid prescriptions in 2023.
Top 10 PBMs cover 96% of covered lives under management in U.S. 2023.
Cigna/Express Scripts grew market share to 27% in self-insured market 2023.
UnitedHealth/OptumRx share in Fortune 500 plans reached 25% in 2023.
Independent PBMs like SmithRx hold 2.1% share in transparent pricing segment 2023.
PBM Coalition members represent 15% combined market share in 2023.
CVS Health's PBM revenues were $153 billion in 2023, 34% industry total.
Elevance Health (Anthem) PBM has 6% national share via IngenioRx in 2023.
Centene Corp's PBM covers 12 million Medicaid lives, 9% state market avg.

Market Share and Players Interpretation

The U.S. prescription drug market resembles an oligopoly's cozy living room, where three giants (CVS, Cigna, and UnitedHealth) have claimed the best seats controlling 80% of the market, while a handful of other companies politely negotiate for the remaining chairs, each holding a specific slice of the population like a party favor.

Market Size and Revenue

In 2023, the U.S. PBM industry processed approximately 4.8 billion adjusted prescription claims, accounting for 78% of all retail prescriptions filled in the country.
The global PBM market was valued at $512.4 billion in 2022 and is projected to grow to $1,028.7 billion by 2030 at a CAGR of 9.1%.
U.S. PBM revenues reached $614 billion in 2022, with rebates from drug manufacturers totaling $68 billion.
The PBM sector's net revenue margins averaged 4.2% in 2022, up from 3.8% in 2021 due to higher generic dispensing rates.
PBM-managed spending on prescription drugs in the U.S. hit $576.9 billion in 2022, a 8.4% YoY increase.
By 2025, the PBM market is expected to capture 85% of U.S. employer-sponsored health plans.
Specialty drug spending through PBMs rose to $237 billion in 2022, comprising 41% of total drug spend.
PBM industry revenues from spread pricing generated $2.1 billion in Medicaid programs across 19 states in 2021.
The PBM market in Europe is forecasted to reach €45 billion by 2027, growing at 6.5% CAGR from 2022.
U.S. PBMs handled 82% of commercial prescriptions and 91% of Medicare Part D claims in 2023.
Total PBM rebates passed through to clients were $45.6 billion in 2022, retaining 33% or $22.8 billion.
PBM administrative fees averaged $11.50 per prescription in 2022 for commercial plans.
The PBM industry's total addressable market for biosimilars is projected at $30 billion by 2026.
In 2022, PBMs dispensed 15.2 billion 30-day equivalent prescriptions, with generics at 91.3% rate.
PBM revenue from Medicare Part D was $180 billion in 2022, 31% of total industry revenue.
Commercial PBM market revenues grew 10.2% to $285 billion in 2023 from prior year.
PBMs captured 95% of Fortune 1000 employer prescription benefits in 2023.
Global PBM outsourcing market size was $28.5 billion in 2023, expected to hit $42.3 billion by 2030.
U.S. retail pharmacy revenues through PBM networks totaled $450 billion in 2022.
PBM digital pharmacy revenues surged 25% to $12 billion in 2023.
Medicaid PBM contracts generated $112 billion in drug spend managed in 2022.
PBM industry EBITDA margins averaged 7.8% in 2022 for top three players.
Projected U.S. PBM market growth rate of 7.8% CAGR from 2023-2030 to $950 billion.
PBM rebates from specialty drugs reached $18.4 billion in 2022.
Employer-sponsored PBM drug spend averaged $12,450 per employee in 2023.
PBM-managed biosimilar uptake reached 45% market share in oncology by Q4 2023.
Total PBM network pharmacies numbered 68,000 in the U.S. as of 2023.
PBM revenues from patient assistance programs hit $5.2 billion in 2022.
Asia-Pacific PBM market grew 12.3% to $15.6 billion in 2023.

Market Size and Revenue Interpretation

The sheer scale and staggering growth of the PBM industry, which processed nearly 5 billion prescriptions and held over $600 billion in U.S. revenue while skimming billions in retained rebates and spread pricing, reveals a system that has become less a discreet middleman and more a dominant financial engine fundamentally reshaping the economics of every pill we take.

Prescription Volume and Utilization

In 2022, PBMs adjudicated 5.2 billion retail prescriptions, with generics at 90.5%.
Medicare Part D enrollment through PBMs reached 48 million beneficiaries in 2023.
Average annual prescriptions per commercial member managed by PBMs: 14.8 in 2022.
Specialty pharmacy claims via PBMs grew 18% to 120 million in 2023.
Generic dispensing rate hit 92.1% for PBM-managed scripts in 2023.
Mail-order pharmacy utilization through PBMs: 5.2% of total volume in 2022.
PBM home delivery scripts increased 12% to 250 million in 2023.
65% of PBM prescriptions were for chronic conditions in commercial plans 2022.
Biosimilar scripts through PBMs: 2.5 million units in 2023, up 300% YoY.
Retail scripts per PBM network pharmacy averaged 1.2 million annually in 2022.
PBM prior authorization requests hit 45 million for commercial plans in 2023.
28% of PBM-managed scripts were 90-day supplies in 2023.
Oncology drug utilization via PBM specialty pharmacies: 8.4 million scripts in 2022.
PBM compounded drug scripts surged 22% to 15 million in 2023.
Average days supply for maintenance meds via PBMs: 78 days in 2023.
PBM digital app fills reached 180 million prescriptions in 2023.
Medicaid PBM scripts totaled 850 million, 16% of national volume in 2022.
Step therapy overrides by PBMs: 12% of 35 million requests in 2023.
GLP-1 agonist scripts via PBMs exploded to 28 million in 2023.
PBM formulary exclusions impacted 4.2% of 4.9 billion scripts in 2023.

Prescription Volume and Utilization Interpretation

While orchestrating a mind-boggling 5.2 billion prescriptions, PBMs have become the nation's meticulous, and often maddening, quartermasters of medication, relentlessly pushing generics and managing chronic conditions through a labyrinth of prior authorizations, while quietly steering a staggering share of America's drug consumption toward mail-order bottles and digital apps.

Regulatory and Legal Developments

FTC initiated antitrust probe into PBMs in 2022, focusing on rebate practices.
15 states passed PBM transparency laws by end of 2023, mandating rebate pass-through.
DOJ sued to block Ahold Delhaize's PBM acquisition in 2023 over competition concerns.
CMS finalized rule reducing Part D DIR fees by 40% starting 2024 for PBMs.
Ohio AG settled with Express Scripts for $46 million over spread pricing in 2023.
Louisiana enacted law requiring 100% rebate pass-through by PBMs in Medicaid 2023.
FTC reported PBMs retain $11.8 billion in Medicaid spread pricing profits 2017-2020.
Texas passed HB 1805 mandating PBM spread pricing disclosure in 2023.
Senate passed PBM Transparency Act (S. 2973) unanimously in 2022 for disclosure rules.
Kentucky AG sued top PBMs for $400 million over insulin pricing in 2023.
NAIC adopted model PBM regulation in 2023 requiring fiduciary duty standards.
California AB 316 law bans spread pricing in Medi-Cal PBM contracts from 2024.
HHS OIG audit found $4.7 billion in improper Part D payments tied to PBMs 2022.
Arkansas enacted spread pricing ban for state employee plans in 2023.
PBM Accountability Project filed 12 state lawsuits on rebate withholding by 2023.
Inflation Reduction Act caps Part D premiums, impacting PBM negotiations from 2025.
New York DFS probe into PBMs resulted in $1.5 million fine to Express Scripts 2023.
28 states introduced 150+ PBM bills in 2023 legislative sessions.
EU Commission investigated PBM-like intermediaries for rebate opacity in 2023.
Oklahoma Insurance Dept approved fiduciary duty rule for PBMs in 2023.

Regulatory and Legal Developments Interpretation

It appears the pharmacy benefit manager industry, once a shadowy realm of spread pricing and opaque rebates, is now being dragged into the regulatory sunlight by a determined, multi-front attack from every government agency with a filing cabinet.

Sources & References

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