Woman’s hand in medicine cabinet

PBM revenue swells along with rising drug costs

Collectively, the four biggest pharmacy benefit managers raked in $150 billion in revenue in the first three months of 2025, reflecting higher spending on medications.

J. Edward Moreno

5/2/25 10:50AM

Pharmacy benefit managers owned by major insurances companies raked in swelling revenues in the first quarter of this year amid growing prescription volumes for more expensive specialty medications, like popular GLP-1 weight-loss drugs.

The four biggest insurance companies — Cigna, UnitedHealth, CVS’s Aetna, and Elevance Health — each have their own PBM. Collectively, the four biggest PBMs made $150 billion in revenue in the first three months of 2025, reflecting higher spending on medications.

Vertically integrated PBMs (those owned by an insurance company) have been criticized over potential conflicts of interest and lack of competition, sparking pushback from lawmakers. The companies say this allows them to get better deals for patients and rein in exuberant prices from drugmakers.

Notably, this quarter CVS announced that it reached a deal with Novo Nordisk to “increase access” to its blockbuster diabetes and weight-loss drugs, Ozempic and Wegovy. This led Eli Lilly, which makes competing weight-loss and diabetes drugs, to fall, because it suggests one of the largest insurers will be pushing patients toward its competitors’ products.

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eBay stock slumps on gloomy Q4 outlook despite solid Q3 earnings

Shares of eBay fell as much as 10.5% in premarket trading on Thursday morning after the company gave a lower-than-expected profit forecast for the important holiday shopping season.

The e-commerce giant reported solid numbers for the third quarter on Wednesday, with revenue up 9% as reported to $2.8 billion and gross merchandise volume rising 10% to $20.1 billion, topping the average analyst forecast of $19.4 billion, per Bloomberg.

However, concerns about the future somewhat overshadowed these results.

eBay outlined its profit outlook for the period ending in December to $1.31 to $1.36 a share, with revenue at $2.83 billion to $2.89 billion. According to Bloomberg-compiled data, this broadly matches Wall Street’s estimates for the top line, but misses on the bottom line, with analysts forecasting EPS to come in at $1.39 — suggesting the company expects some further margin pressure.

The company has been facing macroeconomic challenges since the US ended the de minimis tariff exemption in late August, with the online marketplace reliant on shipments. One small silver lining? CFO Peggy Alford highlighted a “less durable trend” on a post-earnings call: that as commodity prices for precious metals boomed, demand for bullion and collectible coins on eBay spiked.