Medicare Advantage enrollees who filled specialty medications through a pharmacy owned by their insurer got their drugs faster and paid less out of pocket than those who used nonintegrated pharmacies, according to a July study published in Health Affairs Scholar.
The peer-reviewed study was conducted by researchers at Humana Healthcare Research and Brown University School of Public Health, using Humana prescription claims data. It was funded by Humana Healthcare Research.
Five notes:
1. The study examined more than 23,000 MA-PD beneficiaries who filled prescriptions for the 20 highest-volume specialty medications in 2024. Of those, 14,458 used an integrated specialty pharmacy and 8,783 used a nonintegrated specialty pharmacy. Specialty drug classes included osteoporosis (53% of the sample), rheumatoid arthritis (14%), HIV (8%) and dermatology (7%). Oncology medications were not included.
2. After adjusting for demographic and clinical characteristics, enrollees who used the integrated specialty pharmacy received their medications 5.7 days faster than those who used nonintegrated pharmacies, a 35% difference. Integrated beneficiaries had a mean of 10.4 days between the date a prescription was written and the date it was filled.
3. Integrated specialty pharmacy enrollees spent an average of $1,644 per year on pharmacy costs, which was $106 less than nonintegrated beneficiaries filling medications in the same drug class. Out-of-pocket spending on the specialty drug itself was $77 lower for the integrated group. The lower costs were not driven by differences in benefit design, as there was no preferred cost-sharing structure for the specialty medication tier at integrated pharmacies.
4. The study also looked at a subset of 1,063 beneficiaries who used both an integrated specialty pharmacy and an integrated primary care clinic owned by their insurer. That group saw even larger differences, with 40% faster access to medications (6.3 fewer days) and 9% lower total pharmacy costs ($165 less per year) compared with nonintegrated enrollees.
5. The authors noted several limitations, including that some beneficiaries in the nonintegrated group may have used pharmacies that are integrated with other insurers, which could dilute the observed differences. And the study examined only the 20 most common specialty medications, so findings may not apply to other specialty drugs.
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