JP摩根美股医疗科技行业药店收益管理最新PBM调查要点201952937页

NorthAmericaEquityResearch29May2019PharmacyBenefitManagementTakeawaysfromOurLatestProprietaryPBMSurveyHealthcareTechnology&DistributionLisaC.GillAC(1-212)[e-mail]chaelMinchak,CFA(1-212)[e-mail](1-212)[e-mail]/FacilitiesGaryPTaylor(1-212)[e-mail](1-212)[e-mail]ge35foranalystcertificationandimportantdisclosures.J.P.Morgandoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethatthefirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.(contactyourJPMsalespersonfordetails).Intermsofbroaderimplications,theoverallsurveypresentsachallengingdichotomybetween92%overallsatisfactionbut61%citingPBMsas“partoftheproblem”withsomefairlyunflatteringfree-formresponses.ThePBMmodelcontinuestoevolve,withagreaterfocusonintegratedhealthinsurer/PBMmodelsthatmanageoverallhealthcarecosts.Whiletheregulatoryenvironmentormarket-drivenchangescouldimpactthebusinessmodelovertheneartomediumterm,therestilldoappeartobeopportunitiesaroundplandesignelementsthatcanhelptodriveimprovingprofitability.CVSHealth/RxChannel(LisaGill)–CVScontinuestoshowhighsatisfactionratesandscoredwellaroundperceivedtransparency.Whilestillearlyonintermsofpromotingtheintegratedoffering,wewouldexpectthistobemoreofafocusinthesellingseasonnextyear,whiletheintegrationdoesnotappearveryconcerningtocustomers.Specialtyremainsanimportantfocusforplansponsors(CVSisthelargestplayer),whileawillingnessofcustomerstoimplementpreferredornarrownetworkscoulddriveincrementalbenefittothecompany’sretailbusinessovertime.OptumRX/ExpressScripts/Ingenio(GaryTaylor)–BothOptumRXandExpresssatisfactionrateshavegenerallytrendedweakerinrecentyears,seeminglyinconsistentwiththeclaimedhighretentionand2020sellingseasonmomentuminourrecentmngtmeetings.Itisencouragingtoseemajoritybeliefinthepotentialoftheintegratedmedical/pharmamodel(Optumhasbeenonthatstrategythelongest),andperhapsnotsurprisingthatANTM’snewIngenioRXclaimsfairlysmallmindshareatthisearlyjuncture.Oursurveyfocusedonseveralkeyareas,including:1)theenvironmentaroundrebates(stillrelativelylowpenetrationaroundpoint-of-salerebates,andbroadcustomerinterestinmanufacturersmovingtoanetpricemodel);2)verticallyintegratedmodels(amajorityofrespondentsbelieveintegratedmodelscandriveoverallhealthcaresavings);3)transparency(citedbyrespondentsasoneofthebiggestconcernsaroundthecurrentPBMpricingmodel);4)viewsonPBMs’roleaspartoftheproblemorthesolution(givenintenseongoingscrutinyarounddrugpricingandtheroleof“middlemen,”amajorityviewthemaspartoftheproblem;5)satisfactionrates(whichremainhighdespiteviewsonthebusinessmodel);6)primarysourcesofpotentialdisruptioninthenextfiveyears(theregulatoryenvironmentandspecialtythemostfrequentlycitedresponses);and7)opportunitiesaroundplandesign(e.g.,mail,specialty,formularymanagement,retailnetworks).2NorthAmericaEquityResearch29May2019LisaC.Gill(1-212)[e-mail]ctedour25thproprietarysurveyofHRexecutivesatlargeemployersacrosstheU.S.,helpingustogainabetterunderstandingofthecurrentthoughtsaroundkeythemesandtrendsrelatedtopharmacybenefits.Surveyswerefieldedelectronicallyby49respondentsthatareresponsibleformakingbenefitdecisionsforleadingU.S.companies(responseratesvariedslightlybyquestion).Inaggregate,therespondentcompaniescomprised~1.0millionU.S.-basedbeneficiariesandhadaggregateannualdrugspendofroughly$1.6billion.Theresponsesfromthissurveybuildonextensiveindustryknowledgewehavegleanedfromvariouscompanies,consultants,andcustomers,aswellaspriorsurveyworkconductedtwiceannuallysince2007(whichwebelieveprovidesforaninterestingcomparisonandallowsustoevaluatetrendsovertime).BroaderImplicationsTheoverallsurveypresentsachallengingdichotomybetween92%overallsatisfactionbut61%citingPBMsas“partoftheproblem”withsomefairlyunflatteringfree-formresponses.ThePBMmodelcontinuestoevolve,withagreaterfocusonintegratedhealthinsurer/PBMmodelsthatmanageoverallhealthcarecosts.Whiletheregulatoryenvironmentormarket-drivenchangescouldimpactthebusinessmodeloverthenextfewyears,therestilldoappeartobeopportunitiesaroundplandesignelementsthatcanhelptodriveimprovingprofitability.CVSHealth/