Radar on Drug Benefits

Study: Insurer-Integrated PBMs Dominate Medicare Part D, Steer People to Their Pharmacies

  • Feb 27
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    Feb 27, 2025

    Pharmacies owned by companies that own both health insurers and PBMs make up a significant share of the Medicare Part D market, and these “insurer-PBMs” meaningfully steered Medicare beneficiaries to their affiliated pharmacies, according to a new study published in JAMA Health Forum.

    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 more than 10.4 million beneficiaries. They found that 34.1% of all pharmacy spending, 37.1% of specialty pharmacy spending, and 32.1% of non-specialty pharmacy spending occurred through pharmacies owned by The Cigna Group, CVS Health Corp., Humana Inc., or UnitedHealth Group.

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    • Jinghong Chen

    Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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Lauren Flynn Kelly

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Medicare Part D
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