Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2023 Update

Yesterday’s reflections on Asembia’s Specialty Pharmacy Summit included a link to the general session slides. My portion of the deck included an updated mapping of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels. Many readers asked for a standalone version of this infamous chart.

So, for your viewing and slide making pleasure, below you’ll find my latest illustration of the major vertical business relationships among the largest companies.

I estimate that at least half of all public and private U.S. healthcare spending flows through these seven familiar entities: Blue Cross Blue Shield, Centene, Cigna, CVS Health, Elevance Health, Humana, and United Health Group. Just like the heroes in Dawn of the Seven, they are here to serve and protect you.

Enjoy the artwork. In the meantime, I suspect that vertical integration may come up during today's Senate hearing on insulin.

The chart below provides our latest illustration of the major vertical business relationships among the largest companies in the U.S. healthcare system. The companies are listed alphabetically by the name of the insurer. A slightly earlier version of this chart appears as Exhibit 234 in our 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

[Click to Enlarge]

For more background on these companies’ market positions, check out three of our popular analyses:

• The Top 15 U.S. Pharmacies of 2022: Market Shares and Revenues at the Biggest Companies

• DCI’s Top 15 Specialty Pharmacies of 2022: Five Key Trends About Today’s Marketplace

• PBM Market Share, by Total Equivalent Prescription Claims Managed, 2022 (Exhibit 98 in our 2023 report, but to be published on Drug Channels later this month.)