House Calls with AJ & Jonathan: PBM Expert Assesses The Landscape and Competitive Dynamics

UBS hosted the latest House Calls conference call on September 25, 2026, featuring Matthew Loftus, VP and Head of Health Plan/PBM Practice at MAL Life Sciences Consulting. The expert expects the Big Three PBMs to retain their aggregate market share over the next five years, with rebate-free and transparent offerings shifting the location and timing of profit pools rather than displacing vertical integration, purchasing scale and regulatory infrastructure. Smaller and mid-market transparent PBMs can gain share in selected segments, but rising state and federal compliance complexity could drive consolidation. White-label biosimilars represent an increasingly attractive strategy, with an exclusive arrangement estimated to add about 150 bps to margins, potentially extending from inflammatory drugs into multiple-sclerosis and neurodegenerative categories. The largest regulatory risk would be a prohibition on common ownership of PBMs and specialty-pharmacy distribution assets, as forced dive