Pharmacy benefit manager market concentration for prescriptions filled at US retail pharmacies

JAMA

2024-09-10

(Press-News.org) About The Study: In 2023, all 3 payer markets (commercial insurance, Medicare Part D, and Medicaid managed care) for pharmacy benefit manager (PBM) services were highly concentrated, but concentration varied and was highest in Medicare Part D. While CVS Caremark held the dominant share in all 3 payer markets, each of the PBMs appeared focused on a different payer: Express Script’s largest share was in the commercial market, while Optum Rx’s and CVS Caremark’s were in Medicare Part D and Medicaid managed care, respectively. These findings underscore the importance of considering payer-specific concentration when evaluating PBMs’ anticompetitive practices, as the 3 top PBMs may be pursuing different market strategies.

Corresponding Author: To contact the corresponding author, Dima M. Qato, PharmD, MPH, PhD, email qato@usc.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jama.2024.17332)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Pharmacy benefit manager market concentration for prescriptions filled at US retail pharmacies

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