Association between integrated specialty pharmacy care model and pharmaceutical access and costs.

INTRODUCTION

Health care consolidation in the United States has yielded mixed outcomes for patients; however, little is known about the impact of integration between insurers and specialty pharmacies. Through improved data and clinical integration, integrated specialty pharmacy care models may improve health care access and reduce costs for beneficiaries. However, this type of vertical integration may allow increased market power, which could lead to higher costs for beneficiaries.

METHODS

Using Humana prescription claims, our cross-sectional study used adjusted regression analyses evaluating the association between the use of an integrated specialty pharmacy care model with pharmaceutical access and costs for beneficiaries managing complex specialty conditions in 2024.

RESULTS

After adjusting for demographic and clinical characteristics, the integrated specialty pharmacy care model was associated with fewer days from prescription to fill (absolute difference: -5.7 days; 95% CI: -6.7 to -4.7 days) and, reduced yearly beneficiary pharmacy costs (-$106; 95% CI: -$163 to -$49) and yearly beneficiary costs for the specialty drug (-$77; 95% CI: -$129 to -$27) compared with nonintegrated specialty pharmacies. We found additional benefits for beneficiaries who also used integrated primary care services.

CONCLUSION

Integrated specialty pharmacy care models may deliver faster and less costly pharmaceutical care for beneficiaries.