Last month’s unusual consolidation of healthcare provider CVS Health with insurance company Aetna spawned a new behemoth that could pose a more formidable rival to pharma when it comes to securing access for brands.
Nevertheless, it would seem the deal represents a double-edged sword for manufacturers. While the combined company wields greater power to disrupt profits, it could also serve as a catalyst for value-based contracting, something that could give drugmakers a somewhat straighter path to securing coverage for launches of expensive new drugs.
Lines were blurred in December when the board of Aetna, the nation’s third-largest insurer, agreed to a $69 billion cash-and-stock acquisition by CVS Health, which runs the country’s largest drugstore chain.
In the wake of the deal, it would seem pharma marketers can expect a more imposing foe at the negotiating table. Payers have used formulary management the last few years to manage costs. Some have also integrated value frameworks like that of ICER into their assessments.
CVS’ power increases with this move. The company, which also manages pharmacy benefits, wielded its formulary discretion last year with respect to SGLT2 drugs in diabetes, for instance, swapping Boehringer Ingelheim’s Jardiance for Janssen’s Invokana on its list of preferred drugs. The decision cost BI access to some 90 million members.
With the addition of Aetna’s 45 million health plan members, the combined company gains even more clout. Thus, CVS-Aetna should be able to do an as-good or better job extracting price concessions from drugmakers.
One other byproduct could be a net positive for pharma, and that involves facilitating uptake of value-based contracting. Aetna has entered a few pay-for-performance deals on drugs, such as Novartis heart-failure med Entresto, guaranteeing rebates if measures such as hospitalizations prove stubborn.
Aetna’s claims database has been used to measure whether patients hit their goals. The tie-up with CVS bolsters the infrastructure needed to monitor such agreements. The combined company, with CVS’ 9,700 retail locations and 1,100 walk-in clinics, branded MinuteClinic, will have both the payer and provider infrastructure at-hand.
In our payer issue last year, I wrote about how risk-based contracting offered a bridge to better relations between pharma and payers. Yet since then, value-based pricing agreements still have not caught on industry wide. One reason: accessing clinical data and confidence in data accuracy.
Manufacturers are not comfortable assuming risk without data on how a population will use the product. The CVS-Aetna deal, in theory, makes it easier to determine how drugs are being used.
Will outcomes-based contracting now increase? That’s hard to predict. But the deal promises improved data systems to monitor patient usage of drugs. This deal makes CVS-Aetna an even more sophisticated buyer of healthcare products and procedures. And that will have both positives and negatives for pharma.
With everyone worried about a possible Amazon entry into healthcare, further consolidation could redraw the power structure even further. By next year’s payer issue, I expect we’ll have yet more disruption to talk about.
Marc Iskowitz is editor-in-chief of MM&M.