OBJECTIVE
CMS oversees prescription drug coverage for Medicare Part D enrollees. CMS contracts with health insurers, known as plan sponsors, who are responsible for delivering the benefit through a network of pharmacy providers. Under Part D, sponsors often contract with pharmacy benefit managers (PBMs) to manage or administer the drug benefit on a sponsor’s behalf. PBM services may include contracting with pharmacies to establish pharmacy networks and negotiate pharmacy reimbursement rates.
In recent years, the pharmaceutical market has experienced a wave of vertical integration between PBMs, health insurers, and pharmacies. Concern has been raised about the vertically integrated model. One such concern is that, by owning many links in the chain, a vertically integrated Medicare Part D sponsor may inflate drug prices. We will determine the impact of related entity transactions within select vertically integrated entities on the prices for covered Part D drugs.
There are 3 projects in this series.
Project titles will remain unpublished until projects are complete and reports are posted.
ACTIVE PROJECTS IN THIS SERIES (3)
TIMELINE
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April 15, 2024Series Number W-00-24-35912 Assigned
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April 15, 2024Projects Announced
Project A-03-24-00004
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Project A-03-24-00006
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Project A-03-24-00005
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Today3 Projects In-Progress
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Est FY2026Estimated Fiscal Year for Series Completion