DEERFIELD, Ill. — In an 8-K filing earlier this week, Walgreens broke down its Express Scripts business and challenged many assertions that have been made regarding contract negotiations with Express Scripts. The overarching theme of the filing suggested Express Scripts has little to gain without Walgreens within the pharmacy network fold but much to lose.
"Many payers recognize that excluding Walgreens does not provide meaningful savings because our unit prices are competitive with other pharmacies. The vast majority of pharmacy reimbursement is within a narrow band, typically less than 5% of one another," Walgreens noted. "Payers recognize that while excluding Walgreens will result in little to no savings, in some cases it will actually raise costs while causing significant patient disruption, risking gaps in care and increasing administrative costs on plan sponsors caused by member complaints and dissatisfaction."
Approximately 45% of Walgreens' Express Scripts prescription volume comes by way of health plans, a number of which have signed or are in the process of signing agreements that would allow them to retain access to Walgreens, according to the filing. "Many other health plans want Walgreens, but have found their contract with Express Scripts limits their options for now. As a result, these plans’ product offerings are less competitive without Walgreens — in both the Medicare and commercial segments — and we believe they are saving little to no money by Express Scripts excluding Walgreens," the filing reads. "We are confident many of these plans will choose a different PBM partner in the future."
Large employers make up approximately 25% of Walgreens' Express Scripts prescription volume. Walgreens has entered into direct contract or custom network arrangements with select clients in an effort to minimize disruption until those employers are contractually able to switch PBMs, Walgreens reported.
Medicare Part D represents approximately 10% of Walgreens' Express Scripts prescription volume, however patients currently are in the open-enrollment period and Walgreens is proactively reaching out to that group. The remaining Express Scripts volume of 20% is represented by the Department of Defense/TRICARE. Walgreens has attempted to engage in separate negotiations with Express Scripts for this group from contract negotiations in general to no avail, the company reported.
Walgreens noted that there has been no prescription share erosion through September because of the talks, and based on an October comparable gain of 2.5% in prescriptions filled, the company feels confident that prescription growth for the company continues to rise. However, today Walgreens still is part of the Express Scripts network — the current agreement doesn't expire until the first of the year.
"WAG is betting that they are a critical part of the pharmacy distribution network and ESRX is betting that they can successfully sell a PBM network without WAG," noted Credit Suisse analyst Ed Kelly. "We won’t know which company is right until 2012, but both appear ready to find out." Credit Suisse Securities is acting as an adviser to Express Scripts on the announced acquisition of Medco Health Solutions.
Walgreens expects to achieve 97% to 99% of its fiscal 2011 prescription record volume of 819 million prescriptions in fiscal 2012, the company reported. Any share loss should go to CVS or Rite Aid, suggested Kelly, over supermarket or independent pharmacies. Utilizing Metromarket Studies’ database, Credit Suisse determined of the 355 markets in which Walgreens currently operates, CVS’ weighted average market share in these markets is 22% while Rite Aid’s weighted average market share in these markets is 8%.
Walgreens plans to distribute the attached informational materials regarding Express Scripts to various industry participants, the company told the Securities and Exchange Commission. For the full document, click here.