Specialty Payer Landscape.

What is the landscape of the United States payer and pharmacy benefit manager market for specialty medicines, for a company preparing a specialty launch?

The market is concentrated, and the Federal Trade Commission has studied it. The landscape starts from its published findings and says where they are contested.

Concentration, with its source. The FTC reported that the three largest managers processed nearly 80 percent of prescriptions in 2023. The landscape cites it, and notes that this is a staff report in an ongoing study and that one commissioner dissented from its release, arguing that it did not weigh the savings that managers’ negotiation produces.^{1U.S. Federal Trade Commission. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. Interim staff report, 9 July 2024.}

A market with integrated players. The report describes vertically integrated managers that may steer patients to affiliated pharmacies. The landscape records each player’s affiliations as the report states them, and marks any it cannot confirm.^{1U.S. Federal Trade Commission. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. Interim staff report, 9 July 2024.}

What a launch must prepare. The AMCP Format is the common frame for the evidence dossier. The landscape says what it asks and that it is a guidance and not a mandate.^{3Academy of Managed Care Pharmacy. AMCP Format for Formulary Submissions, Version 4.1. December 2019.}

What is shaping it. At Comprehensive length the landscape names the forces: scrutiny by regulators, consolidation, rebate practices, and the entry of new models, with the evidence for each.^{1U.S. Federal Trade Commission. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. Interim staff report, 9 July 2024.,2U.S. Federal Trade Commission. Second interim staff report on pharmacy benefit managers. January 2025.}

The landscape states the assumptions its boundary and its sizes rest on, and says what each gap limits. Examples for this market:

• The FTC’s 2023 figures describe the market the company will launch into.
• The six largest managers are the ones the launch must plan around.
• Affiliations stated in the report are unchanged.

The decision practice behind the memo itself is on the template page.

Any share that is for a different year from the one asked about, any affiliation the landscape could not confirm, and any claim from an interim staff report presented as a final finding.

1. The picture in brief
2. Scope and boundary
3. The market in numbers
4. Who plays where
5. What is shaping it
6. What it means for us
7. What we could not source

1. [1] U.S. Federal Trade Commission. Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. Interim staff report, 9 July 2024. Figures as given in the FTC’s press release and search excerpts; the report was not read in full.
2. [2] U.S. Federal Trade Commission. Second interim staff report on pharmacy benefit managers. January 2025. Known from the search listing; not read.
3. [3] Academy of Managed Care Pharmacy. AMCP Format for Formulary Submissions, Version 4.1. December 2019. Scope and status as given in AMCP’s release and search excerpts; the Format was not read in full.

Links checked 9 October 2026

These are the sources the template drew on. None of their authors or issuers has reviewed it.