While vertical integration and consolidation within the U.S. health system has been a steady trend over the years, now we’re seeing it go even further with the creation of pharmacy benefit manager group purchasing organizations (PBM GPOs), which create yet another tollgate requiring payment in the drug therapy supply chain.
Approximately 80% of all prescription drug claims are managed by the top three PBMs: Express Scripts’ Ascent Health, OptumRx’s Emisar Pharmacy Solutions and CVS Caremark’s Zinc Health Services. Express Scripts, owned by Cigna, has set up Ascent in Switzerland. Ascent’s clients, in addition to Express Scripts and Cigna, include Kroger, Prime Therapeutics and Humana Commercial. Optum Rx, owned by UnitedHealthcare, has chosen Ireland as the headquarters for its GPO, Emisar. Zinc, the GPO created by CVS Health (which owns Aetna), is located within the U.S.