Our April 2015 cover story was about the growing clout of PBMs. Reason number one for the power surge is simply that the companies are getting bigger, and size means added leverage with manufacturers and insurers.
Bigger fish are buying smaller fish and then getting acquired by fish bigger than themselves.
Catamaran bought Restat in 2013 and then in March of this year was acquired by UnitedHealth for $12.7 billion.
Rite Aid bought EnvisionRx a month earlier.
Now CVS is buying Omnicare, the largest provider of drugs to nursing homes in the country.
According to the New York Times’s Dealbook, the three giant PBMs—CVS, Express Scripts, and UnitedHealth—control somewhere between two-thirds and three-quarters of the market, depending on how you do the counting.
This morning’s Wall Street Journal coverage of the CVS-Omnicare deal says it puts CVS in the position of taking advantage of two major factors that are sculpting the shape of American health care and its cost: The demographic bolus of baby boomers making its way through old age and the stratospherically expensive specialty drugs for relatively rare diseases.
A PBM world dominated by superpowers just might rein in the cost of the specialty drugs. The large PBM is a force to be reckoned with. Witness Express Scripts pushing back on Gilead and Sovaldi last year.
But there’s also reason to worry about these middlemen, which have been criticized for their lack of transparency and unilateral say-so over formularies and tiers.