Specializing in Market Access and Reimbursement Strategies

Payer Trend Watch

No. 1

Plan Consolidation Will Bring Pharma Challenges

Over the past few months, consolidation within the healthcare industry has been a hot topic. But it hasn't only been in the pharmaceutical industry. There has been talk lately about payers looking to partner with providers and health systems to in order to provide a greater breadth of healthcare products and services. Rumors have been flying lately about potential mergers with some big names being mentioned, including Aetna, Humana, UnitedHealthGroup, Cigna, and Anthem.

According to an article in Healthcare Payer News, plans are employing a new model, vertical integration, as part of their mergers and acquisitions strategy. Currently, approximately 60% of the health insurance market is served by 10 health plans. So changes to the insurance landscape will reduce the number of available formularies, making it an even greater challenge for pharmaceutical companies to secure preferred positioning.

The future of these vertical acquisitions will include consolidations of for-profit and nonprofit plans as they seek to strengthen their market position and maintain existing profits. Among for-profit plans, they will be looking to target the Medicaid space, increasing their membership to offset profit losses mandated through the Affordable Care Act's medical loss ratio provision. Some plans are integrating with health systems, like Aetna's accountable care organization with Inova Health System in Virginia. On a grander scale, Anthem is employing a shared-risk approach by pooling premiums among 7 major health systems in Los Angeles, California. Another is the risk-based network of providers and hospitals in Philadelphia created by the collaboration between Independence Blue Cross and DaVita HealthCare. Another interesting trend is the collaboration among Blues plans to form regional or interstate alliances to improve healthcare qualities and administrative efficiencies.

As plans are looking to expand their capabilities to improve the customer experience, pharma companies will have to adapt accordingly. They will need to move beyond the traditional brand support strategies and become a partner who can bring meaningful added value to the products they offer.

Strategic Healthcare Alliance (SHA) has successfully designed, developed and implemented truly value-added offerings that combine the needs of managed care decision-makers with the capabilities of various pharma, biotech, and device manufacturers that allow for meaningful partnerships vs. transactional relations. This business-to-business approach allows for mutual success and will continue to be a critical part of manufacturer-payer relations moving forward.

Contact SHA today for more information and find out how we can help you drive market access and maximize reimbursement for your product.

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