Local pharmacy benefit manager (PBM) markets are highly concentrated and more consolidated than previously thought, according to American Medical Association data released as expectations increase for congressional action to address questionable PBM-industry business practices.

The AMA's new 26-page analysis — which focuses on market competition among PBMs that provide so-called middleman services in the drug supply chain and their vertical integration with health insurers — suggests a widespread decline in competition in local PBM markets across the United States.

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