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Study Shows ‘Insurer-PBMs’ Dominate Medicare Part D, Steer Patients to Their Pharmacies

 
• By Jinghong Chen

An analysis of Medicare Part D and other data found that more than one-third of all pharmacy spending went through pharmacies owned by Cigna, CVS Health, Humana or UnitedHealth Group.

PBM-owned pharmacies for specialty and non-specialty drugs filled higher percentages of claims than would be expected without steering, according to a recent study. (Shutterstock)
Key Takeaways
  • Pharmacies owned by the four largest PBMs accounted for more than 34% of all pharmacy spending, according to a recent JAMA study.
  • The insurer-PBMs also steered patients to pharmacies they owned, according to a claims data analysis.
  • The analysis dovetails with ongoing interest in PBM reform legislation on Capitol Hill.

Pharmacies owned by companies with health insurers and PBMs comprise a significant share of the Medicare Part D market, or “insurer-PBMs,” meaningfully steered Medicare beneficiaries to their affiliated pharmacies, according...

The researchers analyzed a 20% sample of Medicare Part D claims data from Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDPs) for 2021, which collectively covered...

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