Cigna to acquire ExpressScripts for $67B
Health insurer Cigna has entered into a agreement to acquire Express Scripts. The combination of Bloomfield, Conn.-based Cigna and the St. Louis-based pharmacy benefits management company is valued at roughly $67 billion, the companies said — a scale similar to that of the ongoing $69 billion acquisition of health insurer Aetna by CVS Health.
As part of the stock-and-cash deal deal, Cigna will assume roughly $15 billion in Express Scripts’ sebt, with Cigna paying $48.75 and 0.2424 shares of its stock per one Express Scripts share. The companies said that the move is aimed at improving consumer choice in healthcare, providing more coordinated care and improving the value of healthcare dollars.
“Cigna’s acquisition of Express Scripts brings together two complementary customer-centric services companies, well-positioned to drive greater quality and affordability for customers,” Cigna president and CEO David Cordani said. “This combination accelerates Cigna’s enterprise mission of improving the health, well-being and sense of security of those we serve, and in turn, expanding the breadth of services for our customers, partners, clients, health plans and communities. Together, we will create an expanded portfolio of health services, delivering greater consumer choice, closer alignment between the customer and health care provider, and more personalized value. This combination will create significant benefits to society and differentiated shareholder value.”
Once the transaction closes, Express Scripts shareholders will own roughly 36% of the combined company, with Cordani leading it as president and CEO. Express Scripts’ president and CEO Tim Wentworth will become president of Express Scripts, with the combined company’s board comprising 13 directors, four of whom will be independent Express Scripts board members. The combined company will be headquartered in Bloomfield, Conn., with Express Scripts continuing to be headquartered in St. Louis.
The deal comes as the healthcare industry works to find value-focused solutions to rising healthcare costs. In in 2016, the $3.3 trillion dollars in healthcare spending made up 17.9% of the United States’ gross domestic product. Both the Cigna-Express Scripts and CVS Health-Aetna mergers appear focused on personalized care through use of analytics. And where the CVS Health-Aetna merger is aimed at turning CVS Pharmacy into the “front door of health care,” as executives at both companies have said, Cigna’s move is meant to streamline the way healthcare is delivered by physicians while making medical, behavioral, specialty pharmacy and other services accessible through more channels.
“Together, our two organizations will help make the healthiest choices the easiest choices, putting health and pharmacy services within reach of everyone we serve,” Express Scripts’ Wentworth said. “Adding our company’s leadership in pharmacy and medical benefit management, technology-powered clinical solutions, and specialized patient care model to Cigna’s track record of delivering value through innovation, we are positioned to transform healthcare. We will continue to have a distinct focus at Express Scripts and eviCore on partnering with health plans, and together, build tailored solutions for health plans and their members. Importantly, this agreement is a testament to the work of our team and their resolute focus on providing the best care to patients, and the most value to clients.”
As consolidation continues in the industry, smaller players — in particular community pharmacists — are growing concerned about their place in the healthcare world and what these pushes for patient access mean for their patients. On Thursday, National Community Pharmacists Association CEO Doug Hoey said that, as the orgnaization assesses the implications of Cigna’s acquisition, “one thing is clear: Consolidation among health care giants leads to fewer choices for patients and plan sponsors.”
Hoey also registered his skepticism about such deals’ ability to curb soaring healthcare costs.
“Companies make claims of cost savings that will benefit patients and health plan sponsors, but the available evidence from previous consolidations suggests otherwise,” he said. “The merger of UnitedHealth and Catamaran a few years ago, for instance, certainly didn’t change the upward trajectory in health care spending.”
A narrowing field of industry players could have big consequences on patients, Hoey said.
“We’re seeing the growing balkanization of the health care industry — a world in which patients may be forced into a health care kingdom – the CVS-Aetna kingdom, the Cigna-Express Scripts kingdom, the UnitedHealth-OptumRx kingdom, et cetera — where the borders aren’t porous, and patients are stuck with what they get. Depending on where you live, that lack of choice could disadvantage patients who are trapped in inflexible pharmacy and health care networks that dictate the decision-making process for the delivery of care.”
AIDSVu puts PrEP data in focus
AIDSVu has rolled out an interactive, state-level map that visualizes the adoption of pre-exposure prophylaxis for HIV, or PrEP, use, showing a 73% year-over-year increase from 2012 to 2016.
The Centers for Disease Control and Prevention have said that an estimated 1.2 million people are at high risk of HIV exposure and would benefit from HIV prevention strategies that include PrEP. The map — from the eight-year-old project developed by Emory University’s Rollins School of Public Health and Gilead Sciences, maker of Truvada, which is commonly prescribed as PrEP — highlights the 77,120 patients taking PrEP in 2016 and breaks patients down by age and sex.
PrEP users are predominantly men, who make up 93% of PrEP patients in 2016. That year, men also comprised 81% of new HIV diagnoses in 2016. And while women made up 19% of 2016’s HIV diagnoses, only 7% of PrEP users were women.
“PrEP is a revolution in HIV prevention and has the potential to dramatically reduce new HIV infections; however, significant disparities in the use of PrEP exist across the country,” AIDSVu principal scientist and Rollins School of Public Health professor of epidemiology Patrick Sullivan said. “Expanding access to PrEP is a core component of Getting to Zero campaigns in cities and states across the country and is one of four key focus areas in the National HIV/AIDS Strategy. We hope that the newly available data on AIDSVu will allow health departments, elected officials, medical professionals, and community leaders to better understand and visualize the realities of who has access to this important prevention tool so they can develop programs and policies to decrease barriers.”
Among the disparities the map highlights is the fact that, while PrEP use increased 880% between 2012 and 2016, the gains have been largely concentrated in a handful of states, with high-risk regions lagging behind. Roughly 50% of 2016 PrEP patients were in New York, Illinois, California, Texas or Florida. And though South accounted for 52% of all new HIV diagnoses in 2016, only 30% of PrEP users are concentrated in the region. Comparatively, the Northeast’s PrEP use rate was more than twice that of the South, West and Midwest, with 47.4 PrEP patients per 100,000 people.
Retail pharmacy has recently taken up the mantle of making PrEP accessible to more patients, with Walgreens last year rolling out PrEP prescribing services its Healthcare Clinic locations. The offering started as a pilot in the Houston area last April, expanding to 17 markets across nine states and Washington, D.C.
“As we continue to help improve the comprehensive health and wellbeing of our patients, while also supporting communities across the nation that are impacted by HIV, we are looking forward to rolling out our prevention initiative more broadly,” Walgreens Healthcare Clinics chief medical officer Pat Caroll said in July.
AIDSVu used de-identified aggregate data from Source Healthcare Analytics with the support of Gilead. SHA uses data from more than 54,000 pharmacies, 1,500 hospitals, 800 outpatient facilities and roughly 80,000 doctor’s offices nationwide, and AIDSVu said it presents a subset of this data. AIDSVu also offers a PrEP locator tool.
Sandoz Canada intros 2 hypertension generics
Sandoz Canada is bringing Canadian patients two new generics to treat hypertension. The Boucherville, Quebec-based company is introducing generic Coversyl (perindopril erbumine) and generic Coversyl Plus (perindopril erbumine/indapamide).
“We are very pleased to be bringing cost-effective generic alternatives to these important medicines to Canadians across the country,” Sandoz Canada president and general manager Michel Robidoux said. “[These products] will help to make high-quality treatment more accessible to Canadians and could save the health care system millions of dollars every year through prescription of high-quality, cost-effective generics.”
Sandoz Canada’s generic Coversyl is an ACE inhibitor indicated to treat mild-to-moderate hypertension and congestive heart failure in adults. It will be available in 2-, 4- and 8-mg dosage strength tablets. The generic Coversyl Plus includes the addition of diuretics. It will be available in tablets with dosage strengths of 2 mg/0.625 mg, 4 mg/1.25 mg and 8 mg/2.5 mg.