changes in pharmaceutical and healthcare … in pharmaceutical and healthcare environment william...
TRANSCRIPT
2/10/2017
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Changes in Pharmaceutical and Healthcare Environment
William Roth, Blue Fin Group
William Roth is the Founding Partner of Blue Fin Group. The conflict of interest was resolved by peer review of the slide content.
Disclosure
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• Review key legislative issues facing community pharmacy.
• Discuss global issues that are affecting community pharmacy long-term.
• Evaluate the reimbursement picture changes that are developing for pharmacy.
• Discuss the movement toward enhanced services for pharmacy and how this is growing and developing.
Learning Objectives
• Pharmaceutical Ecosystem• Overview of the system and macro-situations
• Sourcing The New Mix and channel dynamics• Scramble to sustain profit margin – musical chairs
• Reimbursement and payer dynamics• Pharmacy and Medical Benefit converging
• Pharmacy Business Model Evolution
Discussion Topics
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Key Message Strategic Implication
CMS has a “linked” view of the HC Ecosystem
HC spend $3.2 (growing at 7%) assumed holistic view of the flow of the discounts down to the provider and pharmacy (squeeze out inefficiency)
Reimbursement primary agent of change
Government and Employers dealing with exponentials. Pressuring the economics drives horizontal and vertical consolidation.
Product mix already is driving change
Decline of small molecule, the rise and fall of generics, the explosion of specialty, and the slow adoption of biosimilars – long term stakeholders struggled to evolve
New HC service models and their effort for HC effectiveness
As accountability for science and how it’s delivered intensifies, manufacturers take a much more active role in ensuring optimal provider and patient journeys
New models will emerge for sites of care
It’s a great big game of musical chairs. IHNs create pharmacies. Providers create ITPs. GPOs go to payers and become distributors. Specialty channels emerge. Integration occurs. Channels become providers.
Status quo is being rethought From patient and provider engagement, to channel relationships, to benefit constructs, and account management – there are no sacred cows ‐ all is on the table
Industry Macros At A Glance
Industry Trends and Impacts 2016-2020
Product Mix & InnovationThe shift in mix and the associated economics will drive immediate and profound change. Beyond brand, generic, biotech lies genetic testing, precision, synthetics, regenerative, etc. Future of new science depends upon the commercial model.
Payers, Delivery Systems, Providers, & Channels Are
Integrating Into Something NewLines are more blurred then ever before.
Aligning science and service to create value.
Democratization, Technology, Data and
Human LongevityPlan Sponsor mandates coupled with
Payer visibility (EMR, etc), Genetics and behavioral data increase the ability to influence the Provider and the Patient
Both can be monitored and managed, to see the decline of paternalism and the
rise of the empowered patient
Plan Sponsor Pain, Payer Mix, Convergence of Med and Pharm Benefit, Reimbursement ChangeGovernments and Plan Sponsors objective is cost control. A tipping point is here/fast approaching. Fragmented application of science.
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Products – Understanding Differences In Commercial Models
Brand Generic Specialty Biosimilar Orphan Precision
Cost
Patient Base
Payer Barriers
Complexities
Low
Very large
Low
Rare
Very Low
Very large
Very Low
Very rare
High
Small to Medium
High
PA, Step Edit, Benefit Design, Reimbursement, Storage, Admin
High
Small to Medium
High
PA, Step Edit, Benefit Design, Reimbursement, Storage, Admin
Very High
Very Small
Very High
Find patient, PA, Step Edit, Benefit Design, Reimbursement, Storage, Admin
Very High
Very Small
Uber High
Qualify patient, PA, Step Edit, Benefit Design, Reimbursement, Storage, Admin
Change In Product Mix Drives Significant Change
* Intervening years’ share removed for clarity. Source: Simplified BFG estimates based upon IMS data and BFG Research
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Letting It All Spill Out – 2017 will Not A Good Year For Intermediaries
In the News• Price increases reduced, lack of generic price increases, massive layoffs, hits to stock, generic
company changes, price increases to pharmacies, weak margins.
Happening Or About to Happen• Fragmentation of the prime vendor model• Buy‐and‐bill Med Benefit products have been going “around” full line wholesale for 13 years now –since 2003 – passage of MMA
• Specialty Products deliver very little margin as a % ‐ constrained by FMV
• 70% of wholesalers’ profits from Generics• Generic Wave Machine stops in 2017 • Biosimilars are not the channels’ savior as originally hoped – lower priced brands (less money)• Reimbursement pressure will continue because Plan Sponsors are hemorrhaging• Threat of removal of 11‐20 million covered lives on top of all of this – ACA repeal
BRX Economics On Wholesale Distribution
> $5 billion
2.5%
3.0%
3.5%
4.0%
5.0%
10.0%
> $1 billion > $500 million
Inclusive of prompt pay discountGraph does not introduce complexities of variable cost of goods across provider type and size
Weighted gross margin across branded Rx manufacturers
Variable gross margin contribution (DSA) from branded Rx manufacturers
Sell price below cost less prompt pay discount as weighted market‐basket approach to cost of goods to providers
Wholesaler Operating Costs
Wholesaler Net Profitability
Margin from M
anufacturers
Size of Manufacturer
Lost leaders being repriced
Growing Impact of Specialty
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Evolution Of New Wholesaler Pricing Model
1990s‐2000s Early 2010s Late 2010s
Slow Erosion Of Prime Vendor Model
Brands (C‐5%)
Generics (Net ~ 20%)
Specialty (C‐5%)
Net Effect (C‐5%)
Brands (C‐5%)
Generics (Net ~ 20%)
Specialty* (C~5%)
Net Effect (C‐4.85%)
Brands (C‐5%)
Generics (Net ~ 20%)
Specialty (C‐2%)
Net Effect (C‐3.24%)
85%
10%
5%
100%
65%
10%
25%
100%
35%
15%
50%
100%
*Began carving out RA, Hep C, and others
Economics Of Wholesale Distribution –Fragmenting Bundle
2.5%
3.0%
3.5%
4.0%
10.0%
15.0%
20.0%
Margin from M
anufacturers
30.0%
Specialty Brand Pharmaceuticals Primary Care Brand Pharmaceuticals Generic Pharmaceuticals
$$$ $$$ $$$
Size of Manufacturer In Gross Revenue
5.0%
6.0%
WAC/CC
Synthetic Brands have been the core of pharmaceutical distribution – this piece of the business is declining to 23% of dollars by 2020
Specialty products used to be automatically included in the wholesalers aggressive cost less pricing model. Now they are either being net priced or carved into a separate pricing tier different from the primary care brands.
$ $ $
This is because specialty products are typically sold from manufacturers using conservative approaches to discounting and fee structures.
Profitability on generics fuels much of the distributors margin. When a pharmacy agrees to buy generics from the distributor, the distributor decreases the COGs on brands by another 2‐3% on average.
Due to the end of the patent cliff, the model in generics is about to come crashing down.
Specialty products are much less profitable for the distributor % vs $. Due to M&A activity and
the increased presence of specialty products, manufacturers suppress available monies to distribution.
Movement to unit based pricing remains a progression
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Distributor Impact From Generic Wave
$100 $100$108
$55
$26
$12
$0
$20
$40
$60
$80
$100
$120
0‐6M (1 Gx) 6‐12M (2 Gx) 12M+ (3+ GX)
Reven
ue
Wholesale Revenue Impact
WS Revenue Pre‐Cliff WS Revenue Post‐Cliff
$1.50 $1.50 $1.62
$5.35
$1.50
$0.34
$0.00
$1.00
$2.00
$3.00
$4.00
$5.00
$6.00
0‐6M (1 Gx) 6‐12M (2 Gx) 12M+ (3+ GX)
Margin
Wholesale Margin Impact
WS Margin Pre‐Cliff WS Margin Post‐Cliff
Source: BFG analysis from industry insider interviews. Based on $100 Branded drug with annual 8% price increase. Assumes introduction of exclusive generic for first 180 days, 2nd generic at 6months and 3rd at 12 months with generic at 55%, 26%, 12% of Branded WAC, at 0‐6, 6‐12, 12+ months respectively. Assumes wholesaler margin on Generics at 10‐30% and brand margin assumed at 1.5%
Retailers Impact From Generic Wave
If No Generic Wave Occured Generic Wave
$35 M
$39 M
$44 M
$50 M
$56 M
$63 M
$18 M $19 M $20 M $22 M$23 M
$25 M
$ M
$10 M
$20 M
$30 M
$40 M
$50 M
$60 M
$ M
$100 M
$200 M
$300 M
$400 M
$500 M
$600 M
2011 Proj2012
Proj2013
Proj2014
Proj2015
Proj2016
Margin
Revenue
Pre‐Cliff Brand Rev Pre‐Cliff Generic Rev
Pre‐Cliff Brand Margin Pre‐Cliff Generic Margin
$35 M
$30 M$32 M
$35 M$37 M
$39 M
$18 M
$29 M$27 M
$30 M
$35 M$33 M
$ M
$10 M
$20 M
$30 M
$40 M
$50 M
$60 M
$ M
$100 M
$200 M
$300 M
$400 M
$500 M
$600 M
2011 Proj2012
Proj2013
Proj2014
Proj2015
Proj2016
Margin
Revenue
Post‐Cliff Brand Rev Post‐Cliff Generic Rev
Post‐Cliff Brand Margin Post‐Cliff Generic Margin
Source: BFG analysis from 2012 $250M Pharmacy Margin Analysis Project
$58M $59M
$88M $72M
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The Ocean Becomes A Quiet Lake (What’s Left Are BLAS)
$12.0 B
$8.0 B
$28.7 B
$6.4 B
$15.9 B$18.3 B
$9.5 B
$2.3 B
$5.4 B$3.9 B $4.0 B
$.0 B
$10.0 B
$20.0 B
$30.0 B
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Patent Cliff 2010‐2020
Source: 2012 Medco Patent Cliff Report and USPTO . 2012‐2020 Impact by Manufacturer shows only manufacturers with >$1B impact
0%
20%
40%
60%
80%
100%
$.0 B
$3.0 B
$6.0 B
$9.0 B
$12.0 B
$15.0 B2012‐2020 Patent Cliff Impact ($B and % of 2011 Revenue) by Manufacturer
Generics are a losing industry come 2017
Intermediaries Are Scrambling To Weather The Hits
Diversifying businesses, creating alliances, reducing
costs, raising prices to downstream buyers, focusing on Specialty
Consolidating, diversifying, data
business, services to downstream
members, vertically integrating
Diversifying businesses, creating alliances, pursuing networks, reducing costs, focusing on Specialty, IHN integration
Diversifying businesses,
consolidating, creating alliances, reducing costs,
focusing on Specialty, MCO integration
Consider how this would affect your business – do not think in the past
Which Models Are Impacted By These Changes And What Are They Doing?
Wholesale Distributors
IHN GPOs Retailers PBMs
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Evolving Pharmacy Model
No support for BI/BV, copay, no re‐education and no adherence
support+ 50% abandonment issue‐ 25% adherence issue
If economical for SPP, basic support for BI/BV, copay, minimal re‐education and some adherence
support+ 40% abandonment issue‐ 20% adherence issue
If made aware of PS, support for BI/BV, copay, re‐education and no
adherence support+ 10% abandonment issue‐ 10% adherence issue
IF ambulatory services, support for BI/BV, copay, no re‐education and
no adherence support+ 5% abandonment issue
0% adherence issue
IDN
Patient presents in a Specialty Area
HCP prescribes a self‐administrated product –
leaves with an Rx
Problem for the IDN• Lost revenue $$$
Value to external pharmacy
• Risk for IDN – if patient cannot gain access or be compliant –readmitted –lowering reimbursement rates
Problem for Others• Providers – losing all value and
increasing the risk• Patients – do not realize the care
they expect from IDN• Manufacturers – loss of revenue
and drug viewed as either troublesome to Rx or doesn’t work
• Payers – really Plan Sponsors –higher overall cost of care
1 2
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4
3
8 5
6
Retail Pharmacy
Specialty Pharmacy
Mfgr Patient Services
IDN/AmbulatorySpecialty Pharmacy
Optimize The Patient JourneyInclusion is about solving this puzzle
Rx but no fill Start Therapy Compliance Persistency
Abandonment AdherenceTime to Fill
NDC blocks, tiers, growth of closed lives plans, OOP increases, growth of Medicare
Focus on getting the Rx to pharmacy: E-Prescribing at 35% in 2015**
PAs, SEs, testing, benefit mgmt Taking as directed
Counseling and training
Downdosing
100%>>
Holistic view of the patient Rich education and support Monitoring
According to AMCP*, the rates of abandonment and adherence result in 15‐45% loss of revenue
Engagement 1st 3 months Define Regimen Outcomes
5‐40%* X% 20% 20%
Was never sufficiently addressed by industry because of competing priorities and degree of effort required to change
Side-effect mgmt
Education - outcome
* AMCP JMCP 2015 adherence reports** Surescript article August 2016
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If Not, Manufacturers And MDs Will Solve It
Attract Patients (Identify) Easy access to passionate people and high quality information on disease, therapy, payer coverage and service model
Acquire Patients (Access) Overall service model that supports provider confidence in ability to initiate therapy and get reimbursed
Convert Patients (Start) Services that support provider reimbursement, patient payment, training and first dose coordination
Support Adherence (Regimen) Services that support, engage and empower patient and caregivers
Retain Patient (Brand Loyalty) Communication about alternate therapies in manufacturer disease state portfolio, initiated by signal of risk to switch or discontinue
Patient Services – Optimizing the Patient Journey
Symptoms, Diagnosis, Select
Therapy
Ensure Coverage, Select Site of Care
Address Unique Patient Needs
Initiate First DoseComplete Therapy
Regimen
• 24 hour hotline• Info for patients and caregivers (disease, therapy options, payer coverage) Disease info
• Info for providers (clinical info, payer coverage info)
• Referral processing
• BI / BV• Provider education
• Patient education
• Copay support• PAP• Foundation support
• Denial appeals• Transportation services
• REMS requirements
• Coordination / scheduling support
• Provider billing assistance
• Provider training• Patient training• Reimbursement hotline
• Case management• Risk‐driven reminders
• Adverse event handling
• 24 hour hotline• Behavioral coaching
• Peer‐to‐Peer Mentoring
• Virtual communities
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Specialty Pharmacy has Taught What is Possible
ReimbursementClinical Data AnalyticsHotline Support
• Call Center Scripting
• Call Center Management
• Call Triage
• Billing and Coding
• Sales Rep Support
• Market Preparation Support
• Benefit Verification
• Prior Authorization
• Pre‐certification
• Medical Appeals
• Financial Appeals
• Co‐Pay Assistance
• Alternative Funding
• Medicare Part D
• Patient Assistance Program Management
• Clinical Trial Conversion
• Compliance / Adherence Support
• Nurse Training & Coordination of Patient Training
• Linkages to Outcomes, ACOs, PCMHs
• Role of Pharmacy integrated with collaborative care
• Recommending alternative therapies for holistic pharmacoeconomicreasons
• Weekly, Monthly, and Quarterly Reporting
• Hotline Metrics
• Service Metrics
• Reimbursement Metrics
• Compliance Metrics
• Reimbursement Service Metrics
• Web Based Sales Tracker Utility
• Physician Web Portal
• Data Aggregation Services
Pharmacy
• Patient Referrals
• Pick, pack and shipment of drug to patient / site of care
• Collection of patient co‐pay
• Submit claims to payers
• Receive reimbursement from payers
• Switching of patients to alternative therapies for economic reasons
• Inventory Management
Current View of Retail Pharmacy
Direction of Retail Pharmacy
IDN/HMO To Become The New Model(Delivery of Care At the Right Cost)
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Why? IDNs Gaining Influence And Control
Control of Prescriber(i.e. Strict formulary with mandated internal eRX)
Influence on Prescriber(i.e. reward, penalty or relationship with a prescriber)
Kaiser
Distributor
AcuteNon‐Fed
VA
Control of PatientInfluence on Patient
PBM
Clinic
SPPLTC
GPORetail/Mail
Control = $ leverage
Kaiser Model = best commercial leverage
New Technologies enable the IDN
IDN
Plan Sponsors support this migration
1
2
3
4
Every IDN Is Different – Choose Carefully
IDN w/ limited ambulatory
Capital constrainedStruggling with priorities
Capital pressuredResource constrainedStruggling with priorities
Capital limitedResource limitedSystems multi‐focusedStruggling with priorities
Capital for strategic useResources to allocateRetail pharmacy skillPayer access improvedStruggling with priorities
Capital empoweredResources to allocateRetail pharmacy skillPayer access enhancedStruggling with priorities
Relies on other SPs Supports some SpecialtyRelies on other SPs
Building functionsBuilding technologyBuilding dataFocused TA build‐outOperationally focusedRelies on other SPs
Enhancing functionsEnhancing technologyEnhancing dataFocused TA build‐outPerformance focused
Innovating functionsInnovating technologyInnovating dataFull TA build‐outIntegrated Care
IDN w/ small ambulatory
No systems/data
IDN w/ ambulatoryBasic systems/data
IDN w/SPIntermediate systems/data
IDN w/ large SPAdvanced systems/data
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IDN Pharmacy Will Take Time To Mature: Stages of Excellence
101Rx Journey(Adjudication)
201Enhanced Rx Journey
(Case Management)
301Care Journey
(Medical Intelligence)
401Outcomes Journey
(Patient Reported Outcomes)
Varies by TAPrescriber dataPatient (de‐identified)Patient attempts therapyInsurance benefits (time)Prior AuthorizationStep EditsTier statusPrescription overviewPrescribed supply Dispensed as WrittenElectronically subscribedPatient Out of PocketAssistance amountAssistance programStatus (time to fill)AbandonmentShipping details
Facility typeBasic Patient DataSmoker, pregnant, weight, heightICD9 code (I,II,III)Prior diagnosis (I,II,III)Prior treatmentCombo‐therapySource of patientInvention date/methodTest conductedLast surgery dateLine of therapyEducational interventionAdherence/abandonmentRx HistoryPatient histology
SocioeconomicsWeight trendBlood pressure trend Liver enzyme trendCholesterol trendCurrent/previous diseaseCT Scan resultsGenetic predispositionsCare historySpirometry testSputum testBiopsy resultsBehavioral data Dates of behavior changeDrug interaction risksDrug/treatment response
Physical well‐beingSocial/family well‐beingRelationship with doctorEmotional well‐beingFunctional well‐beingTreatment responseDuration of responseProgression free survivalDisease free survivalMass sizeBehavioral changes
Open Preferred Limited Exclusive
• > 100k patients
• Low control
• Low touch service
• No data visibility
• No limit on access
• 100k – 20k patients
• ⇧ control
• Low touch service
• ⇧ data visibility
• No limit on access; list of preferred partners
• 20k – 5k patients
• ⇧ control
• Medium touch service
• ⇧ data visibility
• 1 SPP/$1,000 drug cost
• 1 SPP/100 patients/month
• < 5k patients
• High control
• High touch service
• High data visibility
• 1 SPP
How Network Partners Are Chosen
Level of ControlChannel Access To Drug
These networks can vary by drug AND by type of site of care
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View Of Manufacturer Networks
Open LimitedPreferred Exclusive
•Serves large patient populations (>500k+)
•$ and care poorest•Little effort and cost for the manufacturer
•Product available for all sites of care
•Market dynamics dictate care
•No visibility to patient journey – high rates of abandonment – poor adherence
•Less connection with sites of care
•Discount impacts•Patient services is an afterthought
•More effort and cost for the manufacturer
•Must direct provider and patient
•Payer mandates•MCO/PBM SPs•IDNs/Clinics typically omitted
•80/20 visibility to patient journey –modest improvements on abandonment and adherence
•Still no payer data•Discount impacts•Patient services is a back‐up plan
•Significantly more effort and cost for the manufacturer
•Must direct provider and patient
•Payer network coordination
•MCO/PBM SPs•IDNs/Clinics typically omitted
Benefits
Challenges
•Serves large patient populations (<100k)$ and care enhanced
•Manufacturer Patient Journey requirements now influence care
•(REMS)
•Serves large patient populations (<500k)
•$ and care enhanced•Contracts pharmacy for data/services
•Product available for all sites of care
•80/20 rule serviced
•Serves large patient populations (<10k)
•$ and care optimized•Manufacturer Patient Journey requirements now influence care
•Every patient intervention point managed – no leaks
IDNs have access to products in several classesStrategy is to get the limited and exclusive products to chase the IDN Network
Product type and Reimbursement
Primary Care Pharmacy Benefit
Specialty Pharmacy Benefit
SpecialtyMedical Benefit
Ultimate Economic buyerFocus on high spend and low
patient counts
Plan Sponsor23% of spend*
Plan Sponsor35% of spend*
Plan Sponsor35% of spend*
Economic GatekeeperReal motives are roughly 5%
profit on total volume
PBMBlocks and tiers/copayPush product to cash
PBMPAs and Step Edits
Patient hits deductible fast
MCOPAs and Step Edits
Patient hits deductible fast
Economic AdministratorReal motives are roughly profit on total volume
PharmacyAWP – 18%
Low cost to serve
PharmacyAWP ‐ 20%
Low $ to high cost to serve
ProviderASP + 4.3%
Office visit and admin $
Economic ConsumerIncreasing ownership for
economics – poor knowledge of access and C&P
Patient(low OOP, no deductible impact, potential for
blocks)
Patient(high OOP, hit deductible fast, need for support)
Patient(low OOP, hit deductible fast,
physician supports)
Non‐economic buyer ProviderAccess support is cost
ProviderAccess support is cost
n/aROI for access support
Business Model Large # patient, low dollar, low abandonment, high adherence, directional 3rd
party data
Small # patient, high dollar, high abandonment, low
adherence, actionable direct data
Small # patient, high dollar, high abandonment, low
adherence, mix of actionabledirect data
Understanding Flow Of The Dollar By Product Type And Benefit Type
*Percentage Mix by 2020
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Growing Concern of Pharmacy Profitability
Service Fees/Rebates from manufacturers vary based on multitude of factors. Evaluation as bona fide service and FMV to be determined
SPPs seek 5-6% gross profit to offset 2-3% operating expenses
Reimbursement (BI/BV) cost assumes 30 mins/Rx @$60/hr; and 30 mins for PA on 50% of Rxs
Patient services cost assumes 15 mins/Rx at $40/hr
Pick/pack/ship cost /Rx assumes $15 per shipment
SPP’s profitability drivers: product acquisition cost; revenue from manufacturer contracts (service fee/discount/rebate); reimbursement from payers; and SPP operating costs.
AWP -15% AWP-17% AWP-20%
Wholesale Acquisition Cost $5,950 $5,950 $5,950 Average Wholesale Price (AWP = WAC + 20%)
$7,140 $7,140 $7,140
Reimbursement from Payer (AWP-x%)
$6,069 $5,926 $5,783
Purchase Price from Manufacturer or Wholesaler (WAC-5%)
($5,653) ($5,653) ($5,653)
Reimbursement - Purchase $417 $274 $130 Manufacturer Service Fees (2% of WAC)
$119 $119 $119
Gross Margin $536 $393 $249 Gross (% of WAC) 9.0% 6.6% 4.2%
Reimbursement BI/BV Cost/Rx ($42) ($42) ($42)Patient Services Cost/Rx ($10) ($10) ($10)Pick/pack/ship Costs/Rx ($25) ($25) ($25)Net Profit $/Rx $459 $316 $172% of WAC 8.1% 5.5% 3%
Sourcing Will Need to Be Reconsidered
Buyer aggregation
Exclusive or openExclusive or open
FL WD SDSPP as SD PD Niche GPO
Exchange
3PL Services
Prime Vendor
Arbitrage
Vendor
Arbitrage/Services
Vendor
Arbitrage/Services
Vendor
Arbitrage/Services
Vendor
Arbitrage
Vendor
Services
Vendor
Services
Vendor
Services
Vendor
Services
Buyer Agent
Buyer and Seller Agent
Buyer and Seller Agent
Buyer Agent
Buyer Agent
Buyer Agent
Buyer and Seller Agent
Buyer OR Seller Agent
Seller Agent
•ABC•CAH•MCK•Regionals
•OTN•Onc Supp•ASD•MCK SD•CAH SD•CurascriptSD•FFF
•Caremark•Bioscript•Acreedo•Diplomat•Biologics (MCK)•US Bioservices
•Besse•FFF•PSS•Henry Schein•MCK Medical
•Anda•(VIP)•Harvard•Par‐med•FFF
•Vizient•Premier•Healthtrust•MHA•Gerimed•PBA•IPC•Many in development
•Trxade• In progress
•UPS•Excel•DDN•ICS•CAH SPS•McKesson•Rx Crossroads
•Lash•UBC•McKesson•Sonexus•Envoy
Seller/product aggregation
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• $3.2T at a CAGR of 7% is unsustainable • 7.6% of average employers’ opex is healthcare
• Plan Sponsors want to condense the Ecosystem
• Payers cannot allow diverged Med and Rx
• Changes in Product Mix drive significant change• Scramble to sustain profit margin – musical chairs
• Channels will have to vertically integrate
• Sourcing is fragmenting and will need to be reconsidered
In Summary
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www.consultbfg.com
William RothFounding Partner
@rxchangeagent www.linkedin.com/in/williamroth
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