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Educate Patients About How PBMs’ Vertical Integration Impacts Their Health Care

  • Writer: IPMD
    IPMD
  • Mar 26
  • 2 min read

Imagine walking into your pharmacy only to find that your medication is no longer covered—or worse, you now must pay more because your insurance insists you use a mail-order service. Millions of Americans are facing similar challenges as prescription costs and access to medications become more complex and costly.


At the center of these changes are pharmacy benefit managers (PBMs), powerful middlemen who negotiate drug prices, determine medication coverage, and influence where patients can fill prescriptions. PBMs hold enormous sway over the health care system, directly affecting patients’ costs and access to care.


In recent years, the rise of vertical integration has radically reshaped the PBM landscape. This is a trend in which companies such as CVS Health, OptumRx, and Express Scripts consolidate control over insurance, PBMs, and pharmacies into a single entity. Although these companies claim this integration drives down costs and improves efficiency, the reality is more complicated—and it often leaves patients footing the bill.


What Is Vertical Integration?


Vertical integration occurs when a single company controls multiple layers of the health care process—such as health insurance, PBM services, and pharmacy operations. For example, a company might manage a health plan, decide which medications are covered, and own the pharmacy where patients are required to fill prescriptions.


Although this might seem like an efficient approach to streamline health care, it raises serious concerns about competition, fairness, and rising costs. By controlling every step of the process, vertically integrated companies hold immense power over patients’ health care journeys, from premiums to the pharmacy counter.


Key Players in Vertical Integration


Three major corporations dominate the vertically integrated PBM market, collectively managing pharmacy benefits for over 75% of Americans.. CONTINUE READING

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