Wednesday, April 30, 2014

Drug Channels News Roundup, April 2014: PFE, WAG, UHC, and AAC

Welcome to my latest round-up of noteworthy news stories from the Drug Channels ecosystem. In this issue:
  • Inversion—How a Pfizer/AstraZeneca deal could trigger a Walgreens headquarters move
  • Reversion—Why UnitedHealthcare won't block retail co-pay cards…for now
  • Subversion—Pharmacies stop New York’s AAC efforts
Plus, The Onion provides valuable advice for pharmacies looking to boost their Medicare star ratings.

Pfizer Sees Tax Savings From AstraZeneca Deal, The Wall Street Journal
Tax inversion is in the air! Pfizer’s proposed acquisition of AstraZeneca could allow Pfizer to move its headquarters overseas. According to this Wall Street Journal article: “Pfizer paid a 27.4% effective tax rate last year, compared with 21.3% for AstraZeneca, according to regulatory filings. Every percentage point in tax reduction could add $200 million to Pfizer's net income...”

The politics will be ugly. But if Pfizer pulls off a post-deal tax inversion, then not much will stand in the way of a Walgreens-Alliance Boots move. For my thoughts on the Walgreens situation, see Inversion Uncertainty: Is Alliance Boots Really Acquiring Walgreens? and Walgreens Faces Post-Alliance Boots Inversion Pressure.

BTW, the WSJ had this nifty graphic of Pfizer’s family Tree:

[Click to Enlarge]

UnitedHealthcare’s Pharmacy Retail Coupon Update, UHC web site
In March, UnitedHealthcare (UHC) published a new “Retail Coupons Policy,” which stated: “On July 1, 2014, UnitedHealthcare will be partnering with our network retail pharmacies to discontinue the use of retail copay coupons.” (source)

Not so fast. On April 11,UHC changed its mind, announcing that it would *not* implement a plan to have retail pharmacies “discontinue the facilitation of copay coupons.” (Gotta love the corporate-speak.)

What happened? As I speculated to Drug Benefit News, UHC's retail network was not ready or willing to implement a draconian ban on co-pay programs. The average consumer sees co-pay offset as a discount and is not motivated by vague notions of "increases in overall health care costs." UHC also lacked leverage to force pharmacies to go along with the program.

UHC will need to reconfigure its pharmacy network relationships before trying again. Today, a pharmacy's participation in a payer's narrow network is based primarily on the pharmacy's willingness to accept reduced reimbursements. Looking forward, copay programs could shape PBMs' preferred and limited pharmacy networks. Pay attention to this trend.

New York pharmacists win Medicaid reimbursement fight, Drug Topics
In Drug Channels News Roundup: February 2014, I highlighted New York state’s plan to switch to an average acquisition cost (AAC) pharmacy reimbursement method. Never mind. A massive, pharmacy-led anti-AAC movement killed the measure. According to the article: "More than 6,500 emails opposing reduced pharmacy reimbursements were sent to state legislators the night before the budget was passed." In our third-party payer system, one person's healthcare cost is another person's revenues.

Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating, The Onion
Here’s a good article on the consumerization of healthcare. Primary care provider Dr. Frank Hawley tells The Onion: “I keep a pretty close eye on my reviews, and whenever I see my number fall below four stars I just write out a few extra Adderall or Dexedrine scripts and it’s back up in no time.” Should pharmacies learn from his example to boost their Medicare star ratings?


  1. Hi Adam, love your information. Are you aware of the narrow networks that were signed by two of the largest drug wholesalers here in California? It is a move to managed Medi-Cal. One of the largest PBM's signed with the two PSAO's with MACS around cost and brand being paid at AWP-19% to 19.5% with no co-pays. Chains either declined or were not invited. This will put indies out of business here in the land of the lowest reimbursements, highest rent and wages. Think you have a good story here. Owners are very upset.

  2. Adam, you state "In our third-party payer system, one person's healthcare cost is another person's revenues. "

    Yet the base of the reimbursement was factually incorrect according to the article you link to.

    "First Databank, which the Department of Health commissioned to develop Average Acquisition Cost (AAC) models, mistakenly determined that the median cost to fill a retail prescription in New York State was $6.60. “They determined that it was less expensive to fill a script in the Bronx than in Alabama,” Tracy Russell, executive director of the Pharmacists Society of New York, told Drug Topics."

    In any business, the cost for one person is the other persons revenues.

    In this case the cost wouldn't have even supported most pharmacies, a level of reimbursement so low even chains wouldn't even have accepted.

    Why do you make it seem like the independents won something they shouldn't have?

  3. You are reading too much into my comment. Since "health care costs" are an ongoing discussion topic, I'm merely highlighting how hard it will be to reduce spending.

    Here's a great quote on the topic:

    "[T]he health care sector of any country always has the dual goals of enhancing the quality of life of patients as well as enhancing the quality of life of the providers of health care, and, charity care aside, patients are at once objects of compassion and biological structures yielding cash." -- Uwe E. Reinhardt, economics professor at Princeton University

  4. UNH seems jealous that the copay cards save end users more than their mail order "savings' & PBM rebates (....which they don't share with beneficiaries)