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ACA: For pharmacy retailers, is it helping or hurting?

BY Alaric DeArment

WHAT IT MEANS AND WHY IT’S IMPORTANT — Pharmacy retailers have a relationship with the healthcare-reform law more complicated than most individuals and businesses.

(THE NEWS: "NRF praises House’s decision to repeal ACA." For the full story click here)

On the one hand, healthcare reform means a whole slew of new patients who will be lining up to get their medications at drug stores, supermarkets and mass merchandisers. According to a study published in the July 2012 issue of the journal Health Affairs, the Patient Protection and Affordable Care Act will reduce the number of uninsured people by about 30 million by 2012. As a result, retail sales of prescription drugs are expected to reach $483.2 billion by 2021, compared with $277.1 billion in 2012. In an analysis of the study, Pembroke Consulting’s Adam Fein estimated that healthcare reform would add nearly $26 billion in annual drug spending by 2021, with prescription drugs accounting for 10.1% of healthcare spending, compared with 10% today.

At the same time, the ACA, which the Supreme Court ruled to be constitutional late last month, will impose penalties on employers that don’t offer affordable health insurance to full-time employees when the full law takes effect in 2014. After the decision, the human resources consulting firm Mercer polled more than 4,000 employers, with a majority saying they had been waiting for the court’s decision before developing a strategy to respond to the law’s provisions. Forty percent said they would begin taking action now, while 16% said they would wait until the November elections; Mercer itself said it advised employers to "stay on track" to comply with the law as enacted.

Mercer president for health and benefits David Rahill said that employers with large numbers of part-time employees — including healthcare organizations and retailers — would have the difficult choice of increasing the number of employees eligible for coverage or having them work fewer hours. "With the average cost of health coverage now exceeding $10,000 per employee, a big jump in enrollment is not economically feasible for many employers," Rahill said.

The National Retail Federation represents retailers in a variety of markets that the ACA will affect in a variety of ways, but for pharmacy retailers in particular, it remains to be seen whether the law will be beneficial, detrimental or will even itself out in the end.

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Keep an eye out for Catamaran

BY Rob Eder

WHAT IT MEANS AND WHY IT’S IMPORTANT — We didn’t include this story in this week’s edition of the Fix because we thought SXC and Catalyst picked a really cool name (it’s OK), or even because we think CEO Mark Thierer is one of the brightest executives in the business (he is). It’s because Catamaran is a company to watch.

(THE NEWS: SXC Health Solutions changes name to Catamaran. For the full story, click here)

While everyone has been focused on ESI-Medco, Catamaran has emerged as a strong No. 4 [pharmacy benefit manager], behind UnitedHealth Group. When all of the ESI-Medco hoopla first began, Thierer, on an earnings call, told analysts that the news didn’t concern him that much, and if anything, it created new opportunities to offer sophisticated clients a legitimate alternative in the PBM market. “The big dislocations happening in the industry rght now have driven so many opportunities,” Thierer told the Wall Street Journal.

The new ESI is the classic, old-school PBM model that has come under attack for years. Critics of the model argue that the company is really a one-trick pony, best at driving down pharmacy reimbursements and steering patients into its own mail order business.

CVS Caremark, with its integrated PBM-pharmacy-retail clinic “sweet spots,” is able to bundle a lot of different offerings and create unique products and services in the areas of overlap between each of its business units that none of its competitors can offer in the PBM market. And then there’s Catamaran, which has a unique vision to sell its services a la carte to payers — you can just buy the technology services that SXC started its business with back in the early 90s, when it sold tech solutions to PBM customers before becoming a PBM itself, or you can buy the pharmacy benefit management component, too.

So far, it appears that Catamaran is making traction, including some impressive recent wins, Thierer has noted, such as the three-year contract it picked up in February with Blue Cross Blue Shield of Rhode Island.

To be sure, it has its challenges ahead of it, too, but Thierer believes his company creates a viable alternative in the traditional PBM market. So far, Catamaran — just like its progenitors SXC and Catalyst before it — appears to making believers out of a significant number of payers. That’s why you need to pay attention to this company.

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GlaxoSmithKline to acquire Human Genome Sciences for $3.6 billion

BY Alaric DeArment

LONDON — British drug maker GlaxoSmithKline will acquire development partner Human Genome Sciences for $3.6 billion, GSK said Monday.

The deal, worth $14.25 per share, would give GSK full ownership of the lupus drug Benlysta (belimumab), as well as albiglutide, an experimental drug for diabetes, and darapladib, an experimental heart disease drug.

"We are pleased to have reached a mutually beneficial agreement with HGS on friendly terms and believe the combination of GSK and HGS represents clear financial and strategic logic for both companies and our respective shareholders," GSK CEO Andrew Witty said. "The transaction meets GSK’s strict financial criteria for acquisitions and, we expect, will deliver significant returns over the long term."


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