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This model, touted as “next-generation,” combines retail and specialty and mail services and PBM along with immediate care clinics.
Walgreens and Prime Therapeutics (Prime), a pharmacy benefit manager (PBM), announced a long-term strategic alliance that includes a new retail pharmacy network agreement and the combination of the companies’ central specialty pharmacy and mail service businesses.
“This model combines the retail and mail distribution, in-person and remote medication management, specialty pharmacy and PBM along with immediate care clinics for addressing urgent and chronic conditions. What does this mean for pure-play PBMs?” says Joel V. Brill, MD, chief medical office for Predictive Health LLC, a Managed Healthcare Executive editorial advisor.
The agreement has two parts, according to Prime spokesperson, Karen Lyons:
1. A retail pharmacy network agreement that will give Prime’s health plan and employer clients access to the preferred Walgreens pharmacy network. “Prime’s 22 million members may also benefit from personalized pharmacy services and cost saving opportunities when filling their prescriptions at Walgreens,” Lyons says.
2.A combined central specialty and mail services company, owned by Prime and Walgreens, that is expected to provide operating and purchasing efficiencies on par with industry leaders.
“This model is entirely different from what currently exists today,” Lyons says. “This integrates the PBM, with health plans, with drug store retailer. This alliance is a next-generation model that moves scale and integration to an entirely new level. We’re bringing together some of the most experienced and trusted names in healthcare to combat rising drug costs.”
The existing models include:
• PBMs that are standalone, not connected to health plans or retail pharmacies.
• PBMs that combine with a retailer.
The retail market has seen much consolidation and business alliances between retail chains, specialty pharmacies, PBMs, and drug distributors, says Rick Burnett, PharmD, FACHE, chief operating officer, CompleteRx.
“But there is a great deal of debate over whether these alliances have been able to lower costs for patients due to the lack of transparency regarding PBMs and the manner in which they price pharmaceuticals,” Burnett says.
“We do know that retail chains are trying to increase the health services they provide as the market moves from a model focused on treating acutely ill patients to one focused on preventive health, so it seems the combined data of a retail pharmacy chain, PBM, and specialty pharmacy could be used as part of a health population management strategy to drive care and volumes to pharmacies,” Burnett says.
Prime and Walgreens have entered into this retail pricing agreement in response to health plan clients need to drive more competitive prices in the wake of losses in the health insurance marketplace exchanges and rising drug prices by pharmaceutical manufacturers, according to Lyons.
Although Lyons says that Prime can’t speak to how other PBMs will place Walgreens in their network, but she can verify that “through our long-term retail pharmacy agreement Walgreens will be Prime's core participant in our preferred national network. It’s important to note that this agreement is not exclusive. Health plans have the option of choosing an open network with other pharmacies. However, choosing this more-narrow, preferred network will offer the deepest cost of care opportunities,” she says.
Back in March, Walgreens purchased 24.9% of AmerisourceBergen. While Walgreens’ extension of its agreement with AmerisourceBergen is independent from Prime’s new agreement with Walgreens, it does help both parties be as competitive as possible, according to Lyons.
“Our new agreement allows both Walgreens and Prime operating and purchasing efficiencies,” she says. “Our intent is that this agreement will leverage our combined size so that we can purchase drugs more effectively together and obtain competitive pricing that helps hold down costs for both health plans and consumers.”
The combined central specialty and mail services company will be governed by a separate board of directors and executive team, which will be selected by Walgreens and Prime. Leadership decisions for the company will be announced later this year.
In March, Walgreens formed a partnership with UnitedHealth Group Inc.’s OptumRx, the Wall Street Journal reported. Walgreens also is trying to buy Rite Aid Corp., which would give it control of Rite Aid’s small pharmacy benefits business, EnvisionRx.