HHS’ Office of Inspector General has found that patients in vertically integrated Medicare Part D plans pay substantially higher out-of-pocket drug costs — and that data gaps are preventing a full picture of how consolidation affects pharmacies, according to a May 19 report.
OIG also found that just six out of 11 health plans accounted for roughly 82% of the $275.9 billion in gross Part D spending in 2023, a level of concentration consistent with prior findings from the Federal Trade Commission and the House Oversight Committee.
The National Community Pharmacists Association said the report raises important questions but leaves critical ones unanswered. CEO B. Douglas Hoey said in a statement that the “unholy trinity” of health plans, pharmacy benefit managers and affiliated pharmacies operating under common ownership creates conflicts of interest that drive up costs for patients.
He added that vertically integrated corporations have made it difficult even for the FTC to investigate their market impact, with the agency requiring multiple rounds of compulsory data requests due to what it has described as highly opaque PBM practices.
The NCPA said it looks forward to future OIG findings as the agency works to fill in the gaps left by data limitations in the current report.
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