The employers paying one company for both
In the most recent complete plan year, 256 self-funded health plans bought their pharmacy benefits and their medical administration from the same conglomerate. They cover 3.34 million employees and disclose $629 million in PBM compensation. The arrangement is shrinking as a share of the market, but not where the employees are. Every row below links to the filing behind it.
"The greatest trick the insurance companies ever played was putting the PBMs out there to take all the hits and pushing people to ignore everything else that they're doing."
Mark Cuban, Healthcare Brew, April 2026
The arrangement is shrinking, the headcount is not
Same-parent plans have fallen every year since 2021, from 417 to 256, and from 36.5% of the plans that disclose enough to classify down to 26.9%. The employees did not go with them. The count stays near 3.3 million because one employer, Walmart, is about half of it. Fewer employers use the arrangement; the ones that remain are larger.
Self-funded plans only. "Share" is same-parent plans as a percentage of the plans that name both a PBM and a medical carrier clearly enough to classify. Plan year 2020 sits in the download but not the chart: far fewer filings are captured for that year, so it is not comparable. Plan year 2025 is excluded because its filings are still arriving.
Who holds the 3.34 million
Four parents account for every same-parent plan, and the balance between them has moved. UnitedHealth has lost 83 plans and three quarters of a million employees since 2021. CVS Health has gained. Employees covered, plan year 2024:
Walmart alone is 1.65 million of UnitedHealth's 1.93 million: Optum Rx for pharmacy, UMR (a UnitedHealth company) for medical administration. A further 20 plans covering 151,738 employees pair Prime Therapeutics with a Blue Cross carrier; Prime is owned by Blue Cross plans, so they are counted separately, not as same-parent.
Plans and employees under each parent, by plan year.
Why it matters
When one parent sells an employer its medical administration and its pharmacy benefits, the company negotiating drug prices answers to the company that profits from them. The Break Up Big Medicine Act, which Mark Cuban publicly backs, would force insurers to divest exactly these assets. The three companies the bill targets, UnitedHealth Group, CVS Health, and Cigna, are the top three parents in this table.
The larger finding is the opacity, and it is getting worse. Of 48,886 self-funded plans that filed for plan year 2024, only 953 name both a PBM and a medical carrier clearly enough to classify: 256 same-parent, 677 split, 20 Blues-affiliated. The other 47,933 filings do not say who manages their drug benefit, what they pay, or both. In 2021 the classifiable share was 2.5%; in 2024 it is 1.9%. Transparency is the exception and it is receding.
The 256 plans
Search by employer, PBM, carrier, state, or metro. Click a column to sort. "Same-parent carrier" is the medical carrier or administrator that shares a parent with the plan's PBM; large plans often name several regional carriers, and the others sit behind the "+ others" note. "PDF" opens the signed Form 5500 filing on the Department of Labor's public server.
| Employer | Employees | PBM | Same-parent carrier | Parent | Disclosed PBM comp | Filing |
|---|
Download CSV Download JSON Download the trend 256 rows for plan year 2024, plus every year from 2020 to 2025 in the trend file.
Method
Source: Form 5500 annual filings from the Department of Labor's EFAST2 system, all industries. Every figure on this page is pulled from the public Verzi Health data API, endpoints /rx/employers and /rx/employers/integration, so the page and the API always agree. The table and the headline figures use plan year 2024, the most recent complete year. The trend uses plan years 2021 to 2024. Schedule C names each plan's paid service providers and their compensation. Schedule A names insurance contracts. Self-funded plans buy administrative services rather than insurance, so their medical administrator appears on Schedule C.
Why 2024 and not a later year. A Form 5500 is filed after the plan year closes. A plan year ending in December 2025 is due at the end of July 2026 and may be extended to 15 October 2026, and most large plans extend. As a result plan year 2025 is roughly a third filed at the time of publication, and plan year 2026 will not be filed until 2027. 2024 is the newest year that is complete.
A plan counts as same-parent when its PBM and its medical carrier or administrator belong to one company: Optum Rx with UnitedHealthcare or UMR under UnitedHealth Group; Caremark with Aetna under CVS Health; Express Scripts with Cigna; CarelonRx with Anthem under Elevance. Prime Therapeutics is owned by a group of Blue Cross plans, so Prime beside a Blues carrier counts as blues-affiliated and is excluded from the 295.
Caveats. Compensation is the direct compensation disclosed on Schedule C. It is fees paid to the PBM, not drug spend. One filing reports a negative amount (an adjustment or clawback) and appears here as filed; five disclose no PBM compensation at all and are marked as such. Employee counts are active participants on the Form 5500. Large plans often use several carriers and administrators at once; a plan counts as same-parent when at least one of them shares a parent with the PBM. Plans below 100 participants generally do not file, so the true overlap is larger than 256.