Vertical Payers: “Highly Integrated” by 2026

HMP Market Access Insights (MAI) has been reporting on vertical payer integration since the inception of our primary payer research arm in 2022. Every year, we hear how these national players intend to further enhance their internal integration regarding business operations, policy decision making, and data sharing. However, this year we see a greater than normal ‘bump’ for what the future holds. In short, vertical payers anticipate a very high degree of integration within these critically important areas over the next few years (Figure).

Figure. Percentage of 2024 Vertical Payer Respondents Selecting “High” or “Full” Integration (N = 25).
Source: HMP Market Access Insights 2024 Payer Annual Oncology Trend Report.

• Manufacturer contracting—greatest increase: The most anticipated area of increased integration is in contracting with manufacturers for rebates and discounts. Related data also show a 48% increase in the number of vertical payer respondents anticipating their level of integration in this area going from “None/Little/Moderate” to “High/Full.”
• Internal data sharing—empowering payer leverage: Often related to manufacturer contracting, our respondents expect much greater integrated internal sharing of drug utilization data. Through interviews, we also know that aggregated drug-level clinical outcomes, adherence, and other data will be analyzed across entities, too.
• Health plan vs pharmacy benefit manager (PBM): Within each vertical payer organization, respondents from the PBM entity tend to anticipate lower levels of integration in each of the 4 areas investigated than respondents from the health plan entity.

We look forward to sharing additional insights later this summer when we release our full 2024 Payer Annual Trend Report, part of our suite of Oncology Customer Insights offerings!

Be sure to check out the other reports from HMP MAI:

• IDN Annual Oncology Trend Report
• Annual Landscape Report - Part One
• Community Oncology Annual Trend Report
• IDN Brand Planning Insights Summary
• Coming soon: Community Oncology Brand Planning Insights Summary
• Coming soon: Payer Annual Oncology Trend Report

In the interim, please feel free to reach out to Sara Stewart with any questions you may have!