In a recent government meeting, Professor Brown highlighted the implications of vertical integration among insurers, pharmacy benefit managers (PBMs), and pharmacies, emphasizing a shift in incentives that could adversely affect independent pharmacies, particularly in rural areas.

Brown explained that when these entities operate as a single unit, they control the entire supply chain, acting as both buyers and sellers. This integration fosters a practice known as \"patient steering,\" where large insurers, such as United, leverage their affiliated PBMs to manipulate payment structures. By underpaying independent pharmacies and steering patients towards their own chain or mail-order pharmacies, these integrated systems create economic disincentives for patients to choose independent providers.

The professor noted that this practice not only undermines the financial viability of independent pharmacies but also mirrors challenges faced by smaller grocery stores competing against larger chains. He warned that what was once seen as a potentially pro-competitive landscape has evolved into one that could stifle competition and threaten the existence of independent pharmacies.

The discussion raises critical concerns about the future of healthcare accessibility and the sustainability of independent pharmacies, particularly in underserved communities. As these dynamics continue to unfold, stakeholders are urged to consider the broader implications of such integration on competition and patient choice in the healthcare market.