{"id":548,"date":"2024-09-14T00:26:29","date_gmt":"2024-09-14T00:26:29","guid":{"rendered":"https:\/\/medical-article.com\/?p=548"},"modified":"2024-09-14T00:26:29","modified_gmt":"2024-09-14T00:26:29","slug":"does-pbm-market-share-vary-by-payer-type","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=548","title":{"rendered":"Does PBM Market Share Vary by Payer Type?"},"content":{"rendered":"<p>A paper by <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39255301\/\">Qato et al. (2024)<\/a> quantifies the degree of of pharmacy benefit manager (PBM) market concentration.<\/p>\n<p> Across all payer types, the PBM market was highly concentrated, with an HHI [Herfindahl Hirschman Index (HHI)] of 1972\u2026the HHI was lowest in commercial insurance (1940), with 90 PBM participants, and highest in Medicare Part D (2399), with 21 PBM participants.<\/p>\n<p>Three PBMs dominate in most all markets.  In fact, these three large PBMs (CVS Caremark, Optum Rx, and Express Scripts) account for 73.6% of retail prescriptions filled.  This does vary by payer type. <\/p>\n<p><em>\u2026CVS Caremark alone accounted for 39.2% of PBM services in the Medicaid managed care market, 28.5% in commercial markets, and 33.4% in Medicare Part D, while Express Scripts accounted for 28.0% of the commercial market, approximately twice its share in Medicaid (12.3%) and Medicare Part D (15.4%). Optum Rx and SS&amp;C Health accounted for a greater share of the Medicare Part D market (27.7% and 16.2%, respectively) compared with commercial (16.4% and 2.9%) or Medicaid (15.8% and 1.2%) markets. <\/em> <\/p>\n<p>Chart created based on data from: https:\/\/pubmed.ncbi.nlm.nih.gov\/39255301\/<\/p>\n<p>You can read the full article <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39255301\/\">here<\/a>.<\/p>","protected":false},"excerpt":{"rendered":"<p>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\u2026the HHI was lowest in commercial insurance (1940), with 90 PBM participants, and highest in Medicare Part D (2399),&#8230;<\/p>\n","protected":false},"author":0,"featured_media":549,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-548","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/548"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=548"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/548\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/549"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}