Does PBM Market Share Vary by Payer Type?

A paper by Qato et al. (2024) quantifies the degree of of pharmacy benefit manager (PBM) market concentration. Across all payer types, the PBM market was highly concentrated, with an HHI [Herfindahl Hirschman Index (HHI)] of 1972…the HHI was lowest in commercial insurance (1940), with 90 PBM participants, and highest in Medicare Part D (2399),…

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Federal Watchdog Urges Crackdown on Medicare Advantage Home Visits

Medicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year. In late October, a Health and Human Services inspector general audit found that the insurers pocketed $7.5 billion in 2023 from diagnosing health conditions that…

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Healthcare’s Paper Check Problem

By adopting a modern digital payment solution, payers can streamline operations, improve provider relationships and reduce fraud exposure. Most importantly, they gain a flexible, scalable foundation built to meet today’s demands and tomorrow’s challenges. The post Healthcare’s Paper Check Problem appeared first on MedCity News.

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