by Leslie Small
Though the two major transactions that upended the PBM landscape
— Cigna Corp. buying Express Scripts Holding Co. and CVS Health Corp. acquiring
Aetna Inc. — have already taken place, that doesn't mean the sector won't see
more changes this year, industry experts tell AIS Health.
"The market is evolving," says Brian Anderson, a
principal with Milliman, Inc. The year 2020 will be marked by a presidential
election and significant price pressure on manufacturers, along with pharmacies
trying to retain their margin, he adds, "so it's going to be a really wild
year."
Indeed, 2019 ended with Prime Therapeutics LLC and Express
Scripts unveiling a three-year collaboration in which the latter PBM will
negotiate with pharmaceutical manufacturers, on behalf of Prime's members, for
drugs covered on the pharmacy benefit, as well as provide services related to
retail network contracting.
By teaming up with Prime, Express Scripts will be leading rebate
negotiations and pharmacy network development for 103 million people, Adam
Fein, Ph.D., CEO of Pembroke Consulting, Inc.'s Drug Channels Institute, wrote
in a blog post. "This combined volume of Express Scripts and Prime will
have enormous leverage with manufacturers and pharmacies," he noted.
To Ashraf Shehata, KPMG national sector leader for health care
and life sciences, the Prime/Express Scripts partnership is yet another example
of "pure play" PBMs' move toward consolidation. Given that trend, the
opportunity to scale up both organizations' purchasing power, and "the
ability to kind of lock in Blue clients," Shehata says, "I think it
makes a lot of sense" for the two PBMs to team up.
Employers, meanwhile, are likely to press PBMs of all varieties
for innovative solutions — not just deep drug-pricing discounts — during the selling
season for 2021 contracts, Anderson says.
Therefore, "there'll probably be a lot of new innovators in
the market — people coming up with new products that maybe look and sound
different," he says. "But the question people are going to have to
ask is, how different really is it? And is it really a differentiator in the
marketplace?"
From RADAR on Drug
Benefits
No comments:
Post a Comment