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Tuesday, November 12, 2024

Does PBM Market Share Differ by Payer Kind? – Healthcare Economist






A paper by Qato et al. (2024) quantifies the diploma of of pharmacy profit supervisor (PBM) market focus.

Throughout all payer varieties, the PBM market was extremely concentrated, with an HHI [Herfindahl Hirschman Index (HHI)] of 1972…the HHI was lowest in industrial insurance coverage (1940), with 90 PBM contributors, and highest in Medicare Half D (2399), with 21 PBM contributors.

Three PBMs dominate in most all markets. Actually, these three giant PBMs (CVS Caremark, Optum Rx, and Specific Scripts) account for 73.6% of retail prescriptions crammed. This does range by payer sort.

…CVS Caremark alone accounted for 39.2% of PBM companies within the Medicaid managed care market, 28.5% in industrial markets, and 33.4% in Medicare Half D, whereas Specific Scripts accounted for 28.0% of the industrial market, roughly twice its share in Medicaid (12.3%) and Medicare Half D (15.4%). Optum Rx and SS&C Well being accounted for a higher share of the Medicare Half D market (27.7% and 16.2%, respectively) in contrast with industrial (16.4% and a pair of.9%) or Medicaid (15.8% and 1.2%) markets.

Does PBM Market Share Differ by Payer Kind? – Healthcare Economist
Chart created based mostly on knowledge from: https://pubmed.ncbi.nlm.nih.gov/39255301/

You may learn the total article right here.



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