Use of and Steering to Pharmacies Owned by Insurers and Pharmacy Benefit Managers in Medicare
This cross-sectional study found that insurer-PBM firms represented an important portion of the Medicare Part D market, especially for certain drug classes, and that insurer-PBM firms steered patients to their own pharmacies, despite certain pharmacy network protections in Medicare. These findings underscore the need to understand the impacts of insurer-PBM and pharmacy integration on medication access and costs for Medicare patients.
Authors
- Kayla N. Tormohlen (ORCID: https://orcid.org/0000-0002-4790-4731)
- Genevieve P. Kanter (ORCID: https://orcid.org/0000-0002-3044-7829)
- Mary Beth Landrum (ORCID: https://orcid.org/0000-0001-5055-8473)
- Pragya Kakani (ORCID: https://orcid.org/0000-0002-4727-1241)
- Nancy L. Keating (ORCID: https://orcid.org/0000-0002-8274-4681)
- Alan M. Bond (ORCID: https://orcid.org/0000-0002-1113-5205)
- Chuanxiu Luo (ORCID: https://orcid.org/0000-0001-8600-6670)
- Swayami Navangul
Institutions
- University of Southern California (US)
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Cornell University (US)
Publication Details
- Journal
- JAMA Health Forum
- Published
- 2025-01-10
- DOI
- https://doi.org/10.1001/jamahealthforum.2024.4874
- Citations
- 1
- Primary Topic
- Pharmaceutical Economics and Policy
- Type
- article
- Field-Weighted Citation Impact
- 3.13
Funders
- Arnold Ventures
- Agency for Healthcare Research and Quality
- Defense Health Agency
- National Cancer Institute