Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, & Providers: A 2022 Update

I conservatively estimate that I’ve created about 1,374,613 slides during my career. But there are two slides that people seem to appreciate the most.


One is my chart showing the key channel flows within the entire U.S. pharmaceutical distribution, payment, and reimbursement system.


The other is my mapping of the insurer/PBM/specialty pharmacy/provider organizations that now dominate U.S. drug channels. Below, I provide an updated version of this second chart that reflects some recent transactions and name changes. About half of all U.S. healthcare spending flows through the seven companies shown below.


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