As health care changes, insurers, hospitals and pharmacies team up – Drug for nerve pain boosts high for opioid abusers. (866) 348-2889
Now that federal officials have quashed the mega-mergers proposed by the biggest insurers and blocked a deal between two large community pharmacy chains, established players in the health care industry are venturing beyond their traditional lines of business. Companies are actively looking for partners that will provide an entree into new businesses or a new supply of customers. CVS Health, which started as a community pharmacy chain, operates a large PBM as well as walk-in clinics in its stores. By combining with Aetna, which covers about 22 million people, CVS would be able to direct members to its own mail-order and pharmacy business and to its walk-in clinics, located in its stores, for much of their care. By sharing in the profits or losses of these ventures, the parties say they work more closely to make sure a patient gets the right medicine or has access to a doctor at a nearby clinic instead of resorting to an emergency room. However, employers that purchase coverage on behalf of their workers may have difficulty determining how much they are paying for a given medicine or a particular service, says Edward Kaplan, a senior vice president at Segal Consulting. There is already a lack of transparency when it comes to drug prices, and employers may have even less information if the insurer and the PBM are the same entity.