As Drug Benefit News begins to circulate our annual Outlook Survey to a slew of PBM executives, health plan pharmacy directors and other sources, we’re looking ahead to 2013 for continuing and emerging industry trends. While the pharmacy benefit beat doesn’t necessarily lend itself to “sexy” headlines, I thought it might be interesting to look back at our top stories of 2012 and reflect on how these issues might bode for the year ahead.
“CVS Caremark’s Buy of Health Net PDP Signals Growing Consolidation in Part D” — Drug Benefit News, January 27, 2012
The PBM/drug store chain’s second strategic Medicare acquisition in a year had industry observers forecasting continued consolidation in the Part D space, not just by stand-alone PBMs but by insurers with captive PBMs such as Cigna Corp. And our forecasters were right; Aetna Inc. unveiled plans in August to buy major Part D player Coventry Health Care, Inc.
“RegenceRx Jumps on Outsourcing PBM Bandwagon With Long-Term Catalyst Deal” — Drug Benefit News, March 23, 2012
Before it was acquired by SXC Health Solutions Corp., Catalyst Health Solutions, Inc. was selected as the exclusive provider of PBM services for RegenceRx, which had long handled PBM operations for Blues plans owned by The Regence Group (now Cambia Health Solutions). This nine-and-a-half year deal continued a trend of insurers unloading their captive PBM assets through a variety of structural solutions.
“SXC and Catalyst Make Major Power Play With Long-Awaited, Curiously Timed Deal” — Drug Benefit News, April 20, 2012
I chose this headline over Express Scripts Holding Co.’s historic acquisition of Medco Health Solutions, Inc. because it was such a surprise given the timing — the news that SXC intended to combine with fellow middle market PBM Catalyst came just weeks after the Express Scripts-Medco deal received FTC approval — and signaled aggressive consolidation within the industry by players of all sizes.
“Resolution Leaves Walgreens on Outer Tier of Express Scripts’ New Network” — Drug Benefit News, July 27, 2012
It was a seemingly endless saga, but the impasse between Express Scripts and Walgreen Co. was finally resolved in July, more than a year after Walgreens walked away from contract-renewal discussions with the PBM. The catch was that Walgreens would be in the broadest pharmacy network available to Express Scripts’ clients, demonstrating the growing popularity of and employer comfort around narrow and tiered networks.
“As Plans Await EHB Formulary Guidance, Patient Groups Put the Pressure on HHS” — Drug Benefit News, August 24, 2012
This was one of several articles on HHS’s drawn-out deliberation on formulary requirements for plans participating in health insurance exchanges in 2014. The agency finally released a proposed rule on Nov. 20, and plan sponsors are likely to deliver some pretty heated comments to HHS by the end of the comment period on Dec. 26.
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