Pharmacy Benefit Manager, also Organisationen, die den Zugang zu Medikamenten für die meisten Patienten in den USA aushandeln, bringen Patienten dazu, ihre eigenen Apotheken zu nutzen. Sie sind Teil von Konglomeraten (CVS, UnitedHealth Group, Cigna, Humana), die Versicherungsunternehmen und Apotheken besitzen, was zu Interessenkonflikten führen kann.

I’ve linked to the press release in the post above. In this comment, for those interested, here’s the link to the peer reviewed journal article:

Use of and Steering to Pharmacies Owned by Insurers and Pharmacy Benefit Managers in Medicare

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2828817

From the linked article:

Weill Cornell Medicine researchers have found that pharmacy benefit managers (PBMs)—organizations that negotiate access to medicines for most patients in the United States—steer patients to use their own pharmacies. However, these pharmacies appear less used in Medicare than in other market segments. These PBMs are part of integrated health care conglomerates that own insurance companies and pharmacies, which may create conflicts of interest.

The study, published Jan. 10 in JAMA Health Forum, found that in 2021 a third of all Medicare Part D pharmacy spending and almost 40% of specialty drug spending within Medicare Part D was through pharmacies owned by the four largest PBMs: CVS, UnitedHealth Group, Cigna or Humana.

“However, despite Medicare’s ‘any willing pharmacy’ rules, insurers integrated with PBMs are still capable of steering a substantial portion of their Medicare Part D plan enrollees to their own pharmacies,” noted senior author on the study Dr. Amelia Bond, associate professor of population health sciences at Weill Cornell Medicine. This is especially true among some high-cost specialty drugs. On average, Medicare patients used their own PBM’s pharmacies at nearly 20 percent higher rates than what would be expected without steering.

The market power of PBM pharmacies and firms’ ability to steer patients to their own pharmacies may impact costs, access to independent pharmacies and patient experience. Thus, some states may consider expanding protections like “any willing pharmacy” in general commercial markets.