The short video below—excerpted from DCI’s recent PBM Industry Update 2026: Trends, Challenges, and What’s Ahead video webinar—reviews the shifting market positions of the largest PBMs and explains why vertical integration continues to reshape the industry’s competitive dynamics.
I also discuss the proliferation of smaller PBMs, many of which still depend on the largest PBMs for claims processing, pharmacy networks, rebate negotiation, and other core services. However, the market is entering what we believe will be a significant shakeout phase.
The growing administrative complexity of state and federal regulation will disproportionately burden smaller PBMs that lack the scale, capital, and integrated infrastructure of the largest organizations. Over the next five years, we expect many smaller PBMs to disappear through acquisition, consolidation, or business failure.
Meanwhile, vertical integration will continue to create strategic and financial advantages for the largest healthcare organizations—along with new opportunities to shift profits, manage risk, and coordinate services across multiple parts of the healthcare system.
What do you think?
Can’t see the video? Click here to watch the PBM clip.
ADDITIONAL BACKGROUND AND ANALYSIS
For more on the PBM industry, see these articles and reports: Cathy Kelly at The Pink Sheet also wrote an article about the webinar: PBM Regulation May Bolster Big Three Market Position Versus Smaller Competitors.
340B in 2026: Market Shifts, Policy Battles, and What They Mean for Stakeholders.
Don't miss DCI’s next live video webinar on Friday, June 12, 2026, from 12:00 p.m. to 1:30 p.m. ET. Adam J. Fein and Tyler Novotny will unpack the good, the bad, and the ugly of the 340B program—and what it means for you. Click here to learn more and sign up.
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