Vertical Integration Drives Higher Patient Costs Through Facility and Pharmacy Steering
Vertically integrated health systems are increasingly directing patients to higher-priced facilities for procedures and requiring use of insurer-owned pharmacies that may not offer the lowest prices or stock prescribed medications. The practice affects patients across commercial and government-sponsored insurance, including Medicaid managed care enrollees who face steered networks and limited pharmacy access. The cost increases result from structural market consolidation rather than explicit policy changes, making them difficult for regulators and payers to address through traditional oversight mechanisms.
Medicaid managed care organizations with vertically integrated structures or contracts with integrated delivery systems may replicate these steering practices, increasing costs to state programs and creating access barriers for enrollees.
Managed Care · Pharmacy
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