GAO Finds Part D Insurers Steer Enrollees to Owned Pharmacies
A GAO report examines four large, vertically integrated Medicare Part D plan sponsors that own pharmacy benefit managers and pharmacies, finding their owned pharmacies handled about 24% of drug utilization and 28% of pharmacy payments in 2023. Owned pharmacies were primarily mail-order, while non-owned pharmacies were primarily retail. For at least 94% of the 100 most commonly used drugs, payments and beneficiary cost sharing were lower at owned pharmacies, creating a financial incentive for enrollees to use plan-affiliated pharmacies, a practice GAO calls steering. For some high-cost brand-name drugs, however, cost sharing was up to $340 higher at owned pharmacies. Findings are based on 2023 CMS data and are not generalizable beyond the four selected sponsors or year.