PBM market share grows; HRSA approves 340B rebate pilot
AMA analysis Sept 29, 2026; HRSA pilot reported Oct 1; starts Jan 1, 2027
From Briefing for the week of September 30 – October 7, 2026
What changed
An AMA analysis, as reported by Fierce Healthcare, found the four largest pharmacy benefit managers held 75% of the national market in 2024, up from 70% in 2022. Separately, HRSA approved a 340B rebate pilot covering 10 manufacturers and 21 drugs, starting January 1, 2027.
Why it matters
Concentration among the intermediaries that set drug access and prices concentrates bargaining power. The 340B rebate model changes how safety-net providers receive discounts, and its effects on those providers are untested.
Warrants deeper follow-up. Obtain the AMA report and HRSA pilot terms; compare to prior PBM concentration estimates.
Sources
- Fierce Healthcare (secondary)
- Healthcare Dive (secondary)