--- title: "Pharmacy Benefit Managers Industry" description: "14 SEC filers are classified under the Standard Industrial Classification codes that describe the pharmacy benefit managers industry." canonical: https://www.getswoopr.com/stocks/industries/health-care/pharmacy-benefit-managers/ source: "Swoopr Investment: https://www.getswoopr.com" --- # Pharmacy Benefit Managers Industry ## Direct Answer 14 SEC filers are classified under the Standard Industrial Classification codes that describe the pharmacy benefit managers industry, and their latest annual reports show $970.0 billion of combined revenue and a median operating margin of 0.9%. Investors should still evaluate its revenue model, industry-specific KPIs, valuation framework and the risks that can change the group's economics. ## Industry Overview Pharmacy benefit managers administer prescription drug plans for employers and insurers, negotiating discounts and rebates and processing claims. They earn from fees, rebates and pharmacy spreads, and face scrutiny over transparency. The first numbers to compare across companies here are claims processed, net revenue and gross profit per claim and rebate pass-through. ## Key Industry Metrics - **Claims processed**: Number of prescription claims handled for plan members. Fees are often per claim, so volume reflects clients and utilization. - **Net revenue and gross profit per claim**: Revenue and profit earned for each claim after drug cost. It shows margin and pricing, and falls with pass-through of rebates. - **Rebate pass-through**: Share of manufacturer rebates passed to clients. A higher share lowers the manager's retained rebate income, and clients increasingly request it. - **Client retention**: Share of plan sponsors that renew. Contracts are large and competitive, so renewals show pricing and service strength. - **Specialty drug share**: Portion of spending from high-cost specialty drugs. It lifts revenue and shifts margins, and often moves through the manager's own pharmacy. ## Primary Macro Drivers - **Brand drug pricing and rebates**: Rebates and list prices on brand drugs feed what benefit managers collect, so changes in drug pricing move gross profit per claim. - **Biosimilar adoption**: More use of lower-cost copies of biologics shifts spending away from high-priced originals, which can change rebates and fee structures. - **Client contract cycles**: Employers and plans bid out contracts every few years, so renewal cycles drive claims processed and client retention. - **Regulation**: Rules on rebate pass-through, transparency and spread pricing can change what benefit managers can earn per claim. ## Major Risks - **Federal and state reform**: Federal and state proposals on rebates, ownership and pricing can change how profit is made; watch legislation and regulator actions. - **Client pushback on pricing**: Employers and plans ask for more transparency and pass-through of rebates, which narrows margin; watch client retention and pricing commentary. - **Litigation**: Suits from states, plans and patients over pricing practices can bring costs and change terms; watch legal proceedings. - **Margin compression**: Lower fees, more pass-through of rebates and more competition reduce gross profit per claim; watch net revenue and gross profit per claim. ## Industry Characteristics | Characteristic | Profile | | --- | --- | | Cyclicality | Defensive | | Capital Intensity | Low | | Regulatory Intensity | Medium | | Industry Maturity | Mature | | Geographic Importance | U.S. | ## Pharmacy Benefit Managers Filers in the SEC Record 14 companies with annual reports in the dataset are classified by the SEC in the Standard Industrial Classification codes 5122, 8090. Their latest fiscal years end between 2025 and 2026, and together they reported $970.0 billion of revenue. Median revenue growth over the prior year was 2.2%. Median operating margin was 0.9% and median net margin -3.1%. Median total liabilities were 81% of total assets, and 7 of 14 reported a profit in their latest year. | Company | Revenue | Growth | Operating margin | Net margin | Year | | --- | --- | --- | --- | --- | --- | | [Mckesson Corp](https://www.getswoopr.com/stocks/companies/mckesson-corporation/) | $403.4 billion | 12.4% | 1.5% | 1.2% | FY 2026 | | [Cencora, Inc.](https://www.getswoopr.com/stocks/companies/cencora/) | $321.3 billion | 9.3% | 0.8% | 0.5% | FY 2025 | | [Cardinal Health Inc](https://www.getswoopr.com/stocks/companies/cardinal-health/) | $222.6 billion | -1.9% | 1.0% | 0.7% | FY 2025 | | [Davita Inc.](https://www.getswoopr.com/stocks/companies/davita/) | $13.6 billion | 6.5% | 15.0% | 7.9% | FY 2025 | | [Agilon Health, Inc.](https://www.getswoopr.com/stocks/companies/agilon-health-inc/) | $5.9 billion | -2.1% | -7.8% | -6.6% | FY 2025 | | [Nu Skin Enterprises, Inc.](https://www.getswoopr.com/stocks/companies/nu-skin-enterprises-inc/) | $1.5 billion | -14.3% | 4.4% | 10.8% | FY 2025 | | [Sotera Health Co](https://www.getswoopr.com/stocks/companies/sotera-health-company/) | $1.2 billion | 5.7% | n/a | 6.7% | FY 2025 | | [Viemed Healthcare, Inc.](https://www.getswoopr.com/stocks/companies/viemed-healthcare-inc/) | $270 million | 20.5% | 8.5% | 5.7% | FY 2025 | The 8 largest of 14 by revenue. Source: each company's own annual report as filed with the SEC (XBRL data), figures in U.S. dollars. A company's SIC code reflects its main business as the SEC records it, so it can differ from how an index provider or analyst classifies the company, and a diversified group appears under only one code. ## Where to Go Next The Pharmacy Benefit Managers guide describes how the industry earns money, what to measure and what can go wrong. 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Key performance indicators for the Pharmacy Benefit Managers industry include: Claims processed, Net revenue and gross profit per claim, Rebate pass-through, Client retention, Specialty drug share. Which matter most depends on the company's model, so compare them across several companies rather than relying on one. How cyclical is the Pharmacy Benefit Managers industry? The Pharmacy Benefit Managers industry is generally defensive, meaning demand tends to remain relatively stable regardless of the economic cycle. Companies in this space can provide portfolio stability during recessions, though growth may lag in strong expansions. What are the biggest risks in the Pharmacy Benefit Managers industry? The primary risks for Pharmacy Benefit Managers companies include: Federal and state reform, Client pushback on pricing, Litigation, Margin compression. Investors should assess each company's exposure to these factors and its track record of navigating them. **[Swoopr Editorial Team](https://www.getswoopr.com/authors/swoopr-editorial-team/)** Swoopr's editorial team produces independent investment education content reviewed for accuracy and clarity. We do not provide personalized financial advice. See our [editorial policy](https://www.getswoopr.com/legal/editorial-policy/) and [corrections policy](https://www.getswoopr.com/legal/corrections-policy/).