Cigna’s PBM business shifted from Optum Rx to Express Scripts after the Cigna–Express Scripts combination Express Scripts’ multifaceted strategic relationship with Prime Therapeutics, which now relies on Express Scripts for nearly half of its overall network spend Centene’s 2024 shift from CVS Caremark to Express Scripts TRICARE, which in 2024 began requiring its beneficiaries to use Express Scripts’ Accredo specialty pharmacy or a military pharmacy to fill prescriptions for certain specialty maintenance drugs CVS Caremark (CVS Health). The PBM business is part of CVS Health’s Health Services segment, which includes CVS Caremark, Cordavis, Oak Street Health, Signify Health, and MinuteClinic. For 2025, total PBM 30-day equivalent claims processed fell by 0.9%, to 1.9 billion. CVS Caremark’s claims volume peaked in 2023 at 2.3 billion, prior to the transition of Centene…

The remainder comes from unaffiliated commercial health plans, employers, and Medicaid programs. Prime operates as a pass-through PBM for 23 Blue Cross and Blue Shield health plans and the subsidiaries and affiliates of those plans. Nineteen of these plans collectively own the business. Prime also provides PBM services for more than two million lives through non-Blues health plans and self-funded employer groups. For 2025, Prime reported $55.3 billion in prescription spending and 407 million claims, compared with 2024 figures of $52.7 billion in spending and 411 million claims. These figures include only full-service PBM services and exclude claims from medical specialty and state government solutions. Due to Prime’s relationship with Express Scripts, about half of its prescription claims are included with the Express Scripts figures shown above. In 2022, Prime Therap…