For PBMs, Amazon Pharmacy May Pose Only Indirect Threat

by Leslie Small

Amazon.com, Inc. made a splash in the health care world on Nov. 17 when the online retail powerhouse unveiled new pharmacy offerings that aim to disrupt the prescription drug market with increased convenience and savings.

In addition to setting up its own online pharmacy, Amazon is partnering with one of the three largest PBMs — Cigna Corp.'s Express Scripts — to offer a prescription-savings benefit that will be available to Amazon Prime members. "It can be used for discounts up to 80% off generic and 40% off brand name medications at over 50,000 participating pharmacies nationwide," according to a press release.

Notably, Amazon's new service offers similar functionalities that health insurers, PBMs and major retail pharmacies have included in their prescription-drug shopping tools — but with the twist of making it clear to consumers when it might be cheaper to purchase their drugs without insurance.

To SVB Leerink analyst Stephen Tanal, that constitutes the only notable — and likely minimal — threat to PBMs' business models.

"The way in which it could be potentially somewhat bad for PBMs is pretty indirect," says Tanal. "It's the idea that to the extent that Amazon is now going to be showing every Prime customer two prices for every pharmacy transaction they do with Amazon, it's really going to highlight the disparities of the cost to you of any given drug if you use insurance or if you choose not to use insurance."

"What I worry about a little on the margin is, if a lot of people, a lot of the time, for a lot of different drugs start to see that cash pay's better than insurance, boy, that's not going to help sentiment and people's perceptions of insurers and PBMs," he adds. If that happens, it could increase policymakers' appetite to regulate PBMs, Tanal points out.

Still, Ashraf Shehata, KPMG's national sector leader for health care and life sciences, says that payer-owned PBMs have an advantage that Amazon would be hard-pressed to replicate. "The broader value proposition is the drug spend in combination with the total medical spend," he says, noting that employers, in particular, want to look at the whole picture when trying to keep down costs. 

From Health Plan Weekly