Private Equity Conversations with Fexingo · 2026-08-30 · 13 min
In this episode of Private Equity Conversations, Lucas and Luna examine the quiet consolidation of pharmacy benefit managers, the middlemen who decide which drugs your insurance covers and what you pay at the counter. They focus on a single 2025 deal - the merger of two mid-sized PBMs - and walk through the economics: how PBMs earn fees, keep the spread between list price and negotiated price, and why scale matters so much in a market where three big players already control roughly eighty percent of claims. The hosts discuss the regulatory scrutiny from the Federal Trade Commission, the potential impact on independent pharmacies, and what the trend means for your prescription costs. They also touch on a surprising angle: some private equity firms are now pairing PBMs with their own specialty pharmacies, creating vertically integrated businesses that blur the line between middleman and provider. If you have ever wondered why your drug price changed overnight or why your pharmacy seemed to fight your insurance, this episode offers a concrete look at the mechanics.
Other episodes covering the same guests and topics, from across The B2B Podcast Index.
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