Tuesday, January 05, 2010

Strategic Questions for 2K10 (Part 1 of 2)

Happy New Year!

Welcome back to another year of irreverent, humorous, and potentially insightful viewpoints from Adam J. Fein, your friendly neighborhood blogger. My 2010 looks busy already but I plan to continue sharing my $0.02 with you on Drug Channels.

Here is the first of two posts outlining major topics that I'll be watching in 2010, framed as strategic questions with links to relevant background posts. Please add your own strategic questions in the comments.

Part 2 will appear on Thursday.

I would very much appreciate if you can tell your friends and colleagues about Drug Channels. There are three easy ways to subscribe: Email (use form on left sidebar), RSS feed, or Twitter. Hey, the price is right!

I also want to remind you about the U.S. Pharmacy Industry: Economic Report and Outlook. This report was a best-seller in 2009 (Thank you!) and generated heaps of positive feedback from buyers. Stay tuned for new industry reports coming soon, including the 2010 update to my 2009 Economic Report on Pharmaceutical Wholesalers.


1) How will Federal health care reform affect the drug channel? As I see it, the current House and Senate proposals are neutral to positive for drug channels participants. Pharmacies may fare less well as the uninsured gain coverage, but will benefit from proposal to “fix” the Federal Upper Limit (FUL) and reduce transparency to Average Manufacturer Price (AMP). The political debate will be fierce, especially after Harry Reid’s “cash for cloture” Christmas Eve shenanigans.
2) Will CVS Caremark prove the strategic value of a PBM-Retail combo? I asked the same question last year. My skepticism now seems more justified given the events of the past two months. Caremark has a new boss who can probably re-energize the PBM business (as I told Bloomberg News). But there’s still the nagging problem of explaining how a PBM client benefits when a brick-and-mortar pharmacy is combined with a benefit management business.
3) Will restricted pharmacy networks gain traction? I predict the growth of preferred and restricted networks—retail pharmacy networks using financial incentives or explicit restrictions to direct consumers into specific pharmacies or channels. These networks are common for specialty drugs but on the verge of expanding into traditional retail pharmacies. Keep an eye on the Caterpillar/Wal-Mart/Walgreens deal as well as potential new network structures from PBMs.
4) How quickly will PBMs transition to their new business model? The largest PBMs still rely on dispensing generic drugs via mail-order pharmacies to subsidize benefit management services. They are investing today to combat the commoditization of the core benefit management business and mitigate the risks of a generic-focused profit model. Major strategies include patient-centric branded services, horizontal consolidation, international expansion, and personalized medicine/genomics. The smaller PBMs are attempting to gain traction with alternative pricing models. I expect that we’ll see bold announcements from both groups in 2010.

So, what’s on your list for 2010?

Tune in for my second set of questions on Thursday!


  1. Good list. Wonder what you have in Part 2.

    I'm surprised you didn't list AWP. Will it still be used in retail pharmacy? Will payers make PBMs use something else? How much of a discount off AWP will pharmacies be forced to accept?

  2. 2010 Will Be a Year of Unprecedented Business Press Coverage of PBM Contract Renewals

    The coverage of the State of Texas Retirement System renewal of CVS/Caremark in December was just the beginning.

    There will be tremendous pressure by labor unions and community pharmacies on state agencies to prove that are not just rubber stamping the status quo.

    Aside:the essence of a populist issue is one in which labor unions and small businesses are on the same side.

    Expect 5% plus or minus changes in stock prices with every big win or loss.

  3. What is your view of the pending "Bundle" payment methodology Medicare will impose on the Dialysis industry i.e., patients will be forced to get the necessary dialysis related drugs while being dialyzed via their particular dialysis provider? Essentially, this forces the patient to get their meds from a single source since the meds are all inclusive in their treatment and payment but eliminates free competition?

    I am also curious how these patients will receive meds from their dialysis provider if the provider does not have a current pharmacy already?

    With adherence and compliance already the crux of disease management, a bundled or cap rate may equate to more saving but adding another step for the DM population appears contradictory..

  4. It might take 2 years instead of 1, but expect the emergence of a 4th large independent PBM managing around 400 Mil Rx/Yr, created by consolidation of 3 "mid-major" PBMs.

    Look for SXCI to be the buyer using its richly valued stock and the 4 targets being Health Trans, Argus, and/or MedImpact.(all private) and then possibly Catalyst Rx (public)

  5. Agree and interesting perspective or should I say intelligence. Considering the daily meds necessary, this is a captive audience not to mention Part B, CV and Hypertension revenue streams..A single source provider could also offer the industry a distribution channel to the provider and then patient directly..Add the the ability to enforce compliance and adherence and this becomes very attractive.

  6. What will the drug chains do if there is a reduction in generic margins - essentially reducing the difference between margins from generics vs. branded Rx products?