Costco Unveils Its Own PBM

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Mass merchandiser Costco Wholesale has just started publicizing Costco Health Solutions (CHS), its very own pharmacy benefit manager (PBM). January’s Costco Connection magazine highlights the heretofore publicity-shy business in A Prescription for Success.

Below, I outline how Costco’s PBM strategy exemplifies six key dynamics facing the pharmacy and PBM industries. In this slow prescription growth environment, retail pharmacies are looking for new growth drivers. With its PBM, Costco is emulating CVS Caremark's tactics for driving prescription store traffic. Walmart has a robust narrow network strategy and Walgreen is funding RxAlly and Smart D (but sold its PBM). So, who's next?

Costco is a membership-warehouse club with 447 U.S. locations, most of which have a pharmacy. I estimate total 2012 prescription revenues to be about $1.6 billion, so it didn’t make our list of top pharmacies. Costco operates on lean margins. Gross margins were just 10.7% in its most recent fiscal quarter.

Fun fact: the company sells more than 1 billion rolls of toilet paper a year. (Drug Channels readers are encouraged to insert their own semi-scatological joke here.)

Here are six observations about the Costco Health Solutions (CHS) strategy:

Get Big, Get Focused, or Get Out—Winning in the consolidating PBM industry requires scale or differentiation. Otherwise, cash out gracefully. Believe it or not, starting a PBM is easier than you might think, especially when, like CHS, you can outsource claims processing. If you’re curious about the smaller and regional players, check out this list from the Pharmacy Benefit Management Institute.

Use Brand Equity—Would you like insurance with your 18-roll toilet paper jumbo pak? Costco’s PBM targets self-insured employers located near a Costco warehouse store. Costco is going after the mid-market, i.e., plans with fewer than 20,000 covered lives. Costco has 6.4 million business members. While CHS does not require its clients to be Costco members, it surely helps.

Become Transparent—CHS provides all discounts, rebates, and other revenues back to the employers. Thus, there is no spread between (a) the amount charged by Costco to a plan sponsor and (b) the amount paid by Costco to the retail network pharmacy that dispenses the drug to a consumer. Such pass-through pricing arrangements are often called “transparent,” because the plan sponsor has visibility to prescription costs at the pharmacy.

Embrace Narrow Networks—CHS claims 64,000 retail pharmacies in its network. Plan sponsors, however, are encouraged to set up a preferred network model, in which the consumer has a financial incentive to choose a Costco pharmacy to reduces the payer's costs. Reminds me of how Maintenance Choice boosted CVS Caremark's retail pharmacy business. See Chapter 8 of 2012–13 Economic Report on Retail, Mail, and Specialty Pharmacies for a full update on the narrow networks revolution.

Lead with Generics—Retail pharmacy is becoming dominated by low-cost generic prescriptions, which are increasingly marketed like other consumer products. Costco’s low-cost philosophy fits this new model, so they can build a PBM business with generics.

Partner for Specialty—To compete for the business of dispensing specialty drugs, CHS partners with a larger specialty pharmacy that can provide back-end clinical services and care management. Costco maintain its consumer relationships, while its partner handles such specialty pharmacy services as prior authorization, adherence calls, copay assistance, injection training coordination, and pharmacist consultations. (Sorry, the partner’s name is not public info.)

Prepare for Obamacare—This is not Costco’s first foray into healthcare. Last April, Costco began offering its members Aetna individual insurance policies. (Click here to buy a policy.) The Costco Personal Health Insurance program is currently available in 10 states. Who else will leverage their customers into the brave new world of health insurance?

Now, watch me pull a PBM out of my hat! (Again?)