{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:28:22Z","timestamp":1786375702245,"version":"build-2736575974"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017245","name":"Humana Healthcare Research, Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017245","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjusting for demographic and clinical characteristics, the integrated specialty pharmacy care model was associated with fewer days from prescription to fill (absolute difference: \u22125.7 days; 95% CI: \u22126.7 to \u22124.7 days) and, reduced yearly beneficiary pharmacy costs (\u2212$106; 95% CI: \u2212$163 to \u2212$49) and yearly beneficiary costs for the specialty drug (\u2212$77; 95% CI: \u2212$129 to \u2212$27) compared with nonintegrated specialty pharmacies. We found additional benefits for beneficiaries who also used integrated primary care services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrated specialty pharmacy care models may deliver faster and less costly pharmaceutical care for beneficiaries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag192","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:07:17Z","timestamp":1784722037000},"source":"Crossref","is-referenced-by-count":0,"title":["Association between integrated specialty pharmacy care model and pharmaceutical access and costs"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3423-2980","authenticated-orcid":false,"given":"Alexandra G","family":"Hames","sequence":"first","affiliation":[{"name":"Humana Healthcare Research, Inc , Louisville, KY 40202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4348-4132","authenticated-orcid":false,"given":"Geronimo","family":"Bejarano","sequence":"additional","affiliation":[{"name":"Humana Healthcare Research, Inc , Louisville, KY 40202 ,","place":["United States"]},{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2051-8803","authenticated-orcid":false,"given":"Insiya B","family":"Poonawalla","sequence":"additional","affiliation":[{"name":"Humana Healthcare Research, Inc , Louisville, KY 40202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026081010363632200_qxag192-B1","doi-asserted-by":"publisher","author":"Brown","DOI":"10.1377\/forefront.20240906.397095"},{"issue":"8","key":"2026081010363632200_qxag192-B2","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1377\/hlthaff.2020.00017","article-title":"Consolidation of providers into health systems increased substantially, 2016-18","volume":"39","author":"Furukawa","year":"2020","journal-title":"Health Aff (Millwood)"},{"issue":"3","key":"2026081010363632200_qxag192-B3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.7249\/rhq-10-03-02","article-title":"Environmental scan on consolidation trends and impacts in health care markets","volume":"10","author":"Liu","year":"2023","journal-title":"Rand Health Q"},{"issue":"2","key":"2026081010363632200_qxag192-B4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1056\/NEJMp2405438","article-title":"Medicare advantage and consolidation's new frontier\u2014the danger of UnitedHealthCare for all","volume":"391","author":"Rooke-Ley","year":"2024","journal-title":"N Engl J Med"},{"issue":"3","key":"2026081010363632200_qxag192-B5","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1086\/730454","article-title":"The corporatization of independent hospitals","volume":"2","author":"Andreyeva","year":"2024","journal-title":"J Polit Econ Microecon"},{"issue":"1","key":"2026081010363632200_qxag192-B6","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1056\/NEJMsa1901383","article-title":"Changes in quality of care after hospital mergers and acquisitions","volume":"382","author":"Beaulieu","year":"2020","journal-title":"N Engl J Med"},{"key":"2026081010363632200_qxag192-B7","doi-asserted-by":"crossref","DOI":"10.3386\/w32613","volume-title":"Who Pays for Rising Health Care Prices? Evidence From Hospital Mergers","author":"Brot","year":"2024"},{"key":"2026081010363632200_qxag192-B8","author":"Hulver"},{"issue":"7","key":"2026081010363632200_qxag192-B9","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxaf120","article-title":"The changing landscape of primary care: an analysis of payer-primary care integration","volume":"3","author":"Adler","year":"2025","journal-title":"Health Aff Sch"},{"issue":"7","key":"2026081010363632200_qxag192-B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.23733","article-title":"Medicare Advantage plan and health system vertical integration, 2011-2020","volume":"7","author":"Bejarano","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2026081010363632200_qxag192-B11","doi-asserted-by":"publisher","first-page":"2","DOI":"10.5334\/ijic.4635","article-title":"Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures","volume":"20","author":"Heeringa","year":"2020","journal-title":"Int J Integr Care"},{"issue":"5","key":"2026081010363632200_qxag192-B12","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1377\/hlthaff.2021.00727","article-title":"Price effects of vertical integration and joint contracting between physicians and hospitals in Massachusetts","volume":"41","author":"Curto","year":"2022","journal-title":"Health Aff (Millwood)"},{"issue":"8","key":"2026081010363632200_qxag192-B13","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.2173","article-title":"Quality-of-care outcomes in vertical relationships between physicians and health systems","volume":"5","author":"Ianni","year":"2024","journal-title":"JAMA Health Forum"},{"issue":"9","key":"2026081010363632200_qxag192-B14","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.2875","article-title":"Utilization, steering, and spending in vertical relationships between physicians and health systems","volume":"4","author":"Sinaiko","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"2","key":"2026081010363632200_qxag192-B15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.56592","article-title":"Trends in integration between physician organizations and pharmacies for self-administered drugs","volume":"7","author":"Kakani","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"10","key":"2026081010363632200_qxag192-B16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.18772","article-title":"Association of use of an integrated specialty pharmacy with total medical expenditures among members of an accountable care organization","volume":"3","author":"Soni","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026081010363632200_qxag192-B17","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1377\/hlthaff.21.1.39","article-title":"Integrating care: a talk with Kaiser Permanente's David Lawrence","volume":"21","author":"Goldsmith","year":"2002","journal-title":"Health Aff (Millwood)"},{"key":"2026081010363632200_qxag192-B18","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1377\/hlthaff.2011.0358","article-title":"How Intermountain trimmed health care costs through robust quality improvement efforts","volume":"30","author":"James","year":"2011","journal-title":"Health Aff (Millwood)"},{"key":"2026081010363632200_qxag192-B19","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.20.0119","article-title":"The economic case for vertical integration in health care","volume":"1","author":"Orszag","year":"2020","journal-title":"NEJM Catal Innov Care Deliv"},{"issue":"2","key":"2026081010363632200_qxag192-B20","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1377\/hlthaff.2025.01062","article-title":"Strategic selection and pricing power: Optum's acquisitions of ambulatory surgery centers and physician practices","volume":"45","author":"Lake","year":"2026","journal-title":"Health Aff (Millwood)"},{"issue":"10","key":"2026081010363632200_qxag192-B21","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1001\/jamasurg.2025.2885","article-title":"Surgical outcomes and Medicare Advantage payer-hospital integration","volume":"160","author":"Bejarano","year":"2025","journal-title":"JAMA Surg"},{"issue":"5","key":"2026081010363632200_qxag192-B22","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1377\/hlthaff.2019.00678","article-title":"Provider integrated Medicare Advantage plans are associated with differences in patterns of inpatient care","volume":"39","author":"Meyers","year":"2020","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2026081010363632200_qxag192-B23","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.4874","article-title":"Use of and steering to pharmacies owned by insurers and pharmacy benefit managers in Medicare","volume":"6","author":"Kakani","year":"2025","journal-title":"JAMA Health Forum"},{"key":"2026081010363632200_qxag192-B24","author":"Arkansas General Assembly"},{"issue":"1","key":"2026081010363632200_qxag192-B25","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1257\/app.20240011","article-title":"Disadvantaging rivals: vertical integration in the pharmaceutical market","volume":"18","author":"Gray","year":"2026","journal-title":"Am Econ J Appl Econ"},{"key":"2026081010363632200_qxag192-B26"},{"key":"2026081010363632200_qxag192-B27","author":"McNulty"},{"issue":"3","key":"2026081010363632200_qxag192-B28","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxag047","article-title":"Scope and characteristics of patients filling medications through specialty pharmacies by ownership type","volume":"4","author":"Anderson","year":"2026","journal-title":"Health Aff Sch"},{"key":"2026081010363632200_qxag192-B29","author":"Fein"},{"key":"2026081010363632200_qxag192-B30","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2147\/DHPS.S255893","article-title":"Managing polypharmacy in older adults with cancer across different healthcare settings","volume":"13","author":"Whitman","year":"2021","journal-title":"Drug Healthc Patient Saf"},{"issue":"4","key":"2026081010363632200_qxag192-B31","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"2026081010363632200_qxag192-B32"},{"issue":"3","key":"2026081010363632200_qxag192-B33","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1086\/704756","article-title":"Upcoding: evidence from Medicare on squishy risk adjustment","volume":"12","author":"Geruso","year":"2020","journal-title":"J Polit Econ"},{"issue":"3","key":"2026081010363632200_qxag192-B34","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.70137","article-title":"Health system integration and prior authorization in Medicare Advantage","volume":"61","author":"Shin","year":"2026","journal-title":"Health Serv Res"},{"issue":"10","key":"2026081010363632200_qxag192-B35","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.38994","article-title":"Vertical integration and care experiences among Medicare Advantage beneficiaries","volume":"7","author":"Bejarano","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"6 pt 1","key":"2026081010363632200_qxag192-B36","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1111\/1475-6773.12076","article-title":"Plan-provider integration, premiums, and quality in the Medicare Advantage market","volume":"48","author":"Frakt","year":"2013","journal-title":"Health Serv Res"},{"issue":"11","key":"2026081010363632200_qxag192-B37","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.3536","article-title":"Characteristics of health systems operating Medicare Advantage plans","volume":"5","author":"Hedquist","year":"2024","journal-title":"JAMA Health Forum"},{"issue":"3","key":"2026081010363632200_qxag192-B38","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1377\/hlthaff.2016.0722","article-title":"Provider-offered Medicare Advantage plans: recent growth and care quality","volume":"36","author":"Johnson","year":"2017","journal-title":"Health Aff (Millwood)"},{"issue":"11","key":"2026081010363632200_qxag192-B39","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.18553\/jmcp.2022.28.11.1244","article-title":"Specialty pharmacy turnaround time impediments, facilitators, and good practices","volume":"28","author":"Gabriel","year":"2022","journal-title":"J Manag Care Spec Pharm"},{"issue":"2","key":"2026081010363632200_qxag192-B40","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1377\/hlthaff.28.2.323","article-title":"The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care","volume":"28","author":"Chen","year":"2009","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"2026081010363632200_qxag192-B41","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1002\/hec.4199","article-title":"The persistence of Medicare Advantage spillovers in the post-Affordable Care Act era","volume":"30","author":"Feyman","year":"2021","journal-title":"Health Econ"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag192\/69850957\/qxag192.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag192\/69850957\/qxag192.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag192\/69850957\/qxag192.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:36:45Z","timestamp":1786372605000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag192\/8740299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":41,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag192","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,23]]},"article-number":"qxag192"}}