AI Is Coming for Pharmacy Benefit Managers: Potential Winners and Losers

Pharmacy payment managers (PBMs) beryllium astatine the chokepoint of U.S. cause distribution. They negociate rebates, plan formularies, adjudicate claims, and steer diligent adherence. Modern artificial quality (AI) is designed to compress each of these high-volume, rules-driven processes. As autonomous anterior authorization, real-time formulary optimization, and AI-driven rebate analytics scale, the Big Three PBMs look a structural menace to their bequest borderline pools, portion AI-native vendors and adjacent platforms basal to benefit. Below are 5 stocks ranked by the materiality of that disruption, from the astir exposed (loser) to the astir leveraged (winner).

1. Cigna: Most Exposed to PBM Disruption

Cigna Group (NYSE: CI) owns Express Scripts successful its Evernorth unit, present its ascendant net engine. Evernorth generated $58.44 cardinal successful Q1 2026 revenue, with Pharmacy Benefit Services unsocial astatine $33.00 cardinal (+11% YoY). Cigna Healthcare shrank 21% aft the HCSC Medicare divestiture. Adjusted EPS of $7.79 bushed estimates for the 4th consecutive quarter, and absorption raised FY26 adjusted EPS guidance to astatine slightest $30.35.

Here's the risk: Cigna flagged "expected little contributions from ample Pharmacy Benefit Services lawsuit relationships," pharmacy lawsuit attrition, and "drug pricing changes oregon manufacture pricing benchmark shifts." AI-driven transparency tools and the company's rebate-free pharmacy payment exemplary are reshaping the rebate economics that historically powered Express Scripts. Shares are up conscionable 4.2% twelvemonth to day astatine $286.69, trading astatine a guardant price-to-earnings (P/E) adjacent 9, reflecting capitalist caution contempt operational beats.

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2. Waystar: The AI-Native Winner

Waystar (NASDAQ: WAY) is the clearest beneficiary of healthcare's payment-workflow automation. Q1 2026 gross roseate 22.4% twelvemonth implicit twelvemonth to $313.87 million, with subscription gross up 38% and adjusted EBITDA borderline expanding to 43.1%. Net gross retention reached 111%, and clients generating much than $100K LTM reached 1,433 (+15% twelvemonth implicit year). R&D spending jumped 66% twelvemonth implicit twelvemonth to $18.4 cardinal arsenic the institution integrates the Iodine clinical-AI acquisition and rolls retired its AI-powered recoupment solution.