'Changing landscape'

Tuesday, December 22, 2015

EDEN PRAIRIE, Minn. – OptumRx’s recent purchase of AxelaCare Health Solutions, a home infusion services provider, points to a larger trend of both pharmacy benefit managers and payers bringing other services under their umbrellas, analysts say.

“This is the changing landscape in health care,” said Justin Ishbia, founder and managing partner of Shore Capital Partners, a private equity firm that used to own SCP Specialty Infusion. “They are the payer but they are also the provider in some respects, as well.”

Besides OptumRx, the two other key players in the PBM space are Express Scripts and CVS Health, both of which offer specialty pharmacy and infusion services through Accredo and Coram, respectively.

The acquisition of AxelaCare, which offers both chronic long-term therapy and acute infusion therapies, positions OptumRx as a strong player in this small group, say analysts.

“Coram has both long term and acute, while Accredo does not have the acute, short-term antibiotic component,” said Reg Blackburn, managing director of specialty pharmacy and infusion services for The Braff Group.

With hundreds of specialty drugs in the pipeline—many of which are infusibles—it’s not surprising that PBMs are entering the space, analysts say.

“They are able to capture more of the money they are spending,” said Jonathan Sadock, managing partner with Paragon Ventures. “It comes with a responsibility, too. They have to manage those costs.”