Medicare rules may reduce prescription steering

Medical Xpress January 10, 2025
Weill Cornell Medical College

Weill Cornell Medicine researchers have found that pharmacy benefit managers (PBMs)—organizations that negotiate access to medicines for most patients in the United States—steer patients to use their own pharmacies. However, these pharmacies appear less used in Medicare than in other market segments. These PBMs are part of integrated health care conglomerates that own insurance companies and pharmacies, which may create conflicts of interest.

The study, published Jan. 10 in JAMA Health Forum, found that in 2021 a third of all Medicare Part D pharmacy spending and almost 40% of specialty drug spending within Medicare Part D was through pharmacies owned by the four largest PBMs: CVS, UnitedHealth Group, Cigna or Humana.