Lane Assist for Filling Prescription Drugs

I bought a new car in 2020. It’s the same make and model as my wife’s car, which we purchased two years earlier. Given my limited car maintenance skills, having two of the same things makes it easier for me to remember how to set the clocks, swing out the luggage racks and check the tire pressure.

What I didn’t know was that my version of the car came with standard safety features not available on her car at the time. Lane assist is one of those features. When the car senses I’m drifting too far to the right or left, the mechanical assistant turns the steering wheel one way or the other to keep me in the middle of the lane.

The first time it happened, I instantly assumed something was wrong with the car, got angry and vowed to return to the dealership. Then I read the owner’s manual. Then I shut off lane assist.

I don’t want anyone other than me steering the car. I know better than lane assist whether I should be a little to the right, a little to the left or in the middle, depending on driving conditions and other drivers at that moment. That’s how I learn. As I mentioned in a previous blog post, “Physicians Freaking Out Over Control,” I resent companies shoving smart technology in my face to help me do something that I don’t want help with.

What does this have to do with healthcare? My sentiments above may be the same sentiments people feel when a health plan requires them to go to a specific pharmacy to fill a prescription. It may not be the neighborhood pharmacy around the corner. It may not be the retail pharmacy at the main intersection in town. It may be a pharmacy miles away in the next town or the next county. They are not in control over where they get their prescriptions filled.

They may not realize it, but they are the victims of vertical integration in healthcare, one corporation controlling each stage of production between buyer and seller. The corporation owns the physician who prescribes the drug. The corporation owns the health insurance plan that covers the prescription drug. The corporation owns the pharmacy benefit manager (PBM) that manages the plan’s prescription drug benefits. The corporation owns the pharmacy that fills and dispenses the prescription.

The profit generated at each stage of production accrues to the corporation, not to any entity outside of the corporation. That’s why the patient can’t go to any pharmacy other than the pharmacy dictated by their health plan. The plan steers them to the preferred pharmacy. It’s lane assist but for drugs.

A new study in JAMA Health Forum bears this out. Eight researchers from Weill Cornell Medical College, University of Southern California, Harvard Medical School and Brigham and Women’s Hospital wanted to know whether corporations with a health insurer and PBM under their corporate umbrella steer patients to pharmacies they also own. You know the answer is yes but humor me.

The study pool consisted of Medicare Part D prescription drug claims filed by about 10.5 million patients in 2021 who had health insurance through an insurer-PBM that also owned retail pharmacies. The four insurer-PBMs in the study were Cigna, CVS, Humana and UnitedHealth Group.

The researchers found that patients filled a significantly greater share of their prescriptions by pharmacies owned by an insurer-PBM. For specialty drugs, it was 19.8% more than expected without steering. For non-specialty drugs, it was 13.9% more than expected without steering.

“Insurer-PBM firms steered patients to their own pharmacies, despite certain pharmacy network protections in Medicare,” the study said. “These findings underscore the need to understand the impacts of insurer-PBM and pharmacy integration on medication access and costs for Medicare patients.”

What’s there to understand?

Vertical integration in any industry, including healthcare, isn’t about improving quality, improving service, economies of scale, eliminating waste, reducing costs or streamlining production. It’s about making more money, leaving consumers with less choice and higher prices. Steering patients to pharmacies is simply a means to an end.

It’s time to turn off lane assist for healthcare consumers.

Thanks for reading.