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Cigna’s purchase of healthcare pharmacy benefit manager Express Scripts last month was just the latest insurer/PBM acquisition in an effort to control rising medical treatment and drug costs.
There’s been quite a few pharmacy benefit manager (PBM) acquisitions in healthcare recently, including Diplomat Pharmacy’s acquisition of Pharmaceutical Technologies and the CVS/Aetna merger in 2017. At about the same time as Cigna’s purchase, St. Louis-based Centene invested in RxAdvance, a cloud-based pharmacy benefit manager.
Purchases happening in the healthcare industry are unlikely to affect the workers’ compensation industry, experts said.
“I don’t think overall it’s going to be that big of an impact to workers’ comp, as much as it is to the group health world,” said Sherri Hickey, AVP of Medical Management at Safety National and a former employee of Express Scripts, which purchased workers’ compensation pharmacy benefit manager myMatrixx last year.
According to Joe Paduda, principal of Health Strategy Associates, these kinds of purchases don’t really impact worker’s comp stakeholders.
“Health plans and PBMs are merging to better control care delivery and cost,” Paduda stated. “These merged entities are better positioned to manage all medical care for their members. Work comp is an afterthought at best, as WC drug spend is probably two percent or less than total US spend.”
Express Scripts is 95 percent group health, said Hickey.
Paduda said it’s highly doubtful workers’ comp carriers will follow suit.
“Workers’ comp insurers have seen drug costs drop dramatically over the last six years, so there’s no incentive for insurers to come up with a solution when there really isn’t a problem,” Paduda stated.
Mitchell and Corvel already have or lease access to PBMs, said Hickey.
“Workers’ comp has kind of been in that game in the past already,” she said.
Many of the small players have already been consolidated, Hickey added.