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Effects of Vertical Integration on Medicare Part D

Approximately three-quarters of Medicare Part D enrollees receive their prescription drug benefits through plans offered by five large companies. These large plan sponsors are vertically integrated operations affiliated with their own pharmacy benefit managers and, in many cases, their own mail-order and specialty pharmacies. Congress, the Medicare Payment Advisory Commission, and the media have raised concerns that vertical integration leads to higher prescription drug costs. This study will use existing pricing, payment, and rebate data to provide broader insight into the effect of vertical integration on Part D costs for both the Medicare program and its enrollees.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
March 2024 Centers for Medicare and Medicaid Services Effects of Vertical Integration on Medicare Part D Office of Evaluation and Inspections OEI-BL-24-00240 2025