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From: Glenn Petersen10/28/2017 12:01:15 AM
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Hearing Amazon’s Footsteps, the Health Care Industry Shudders

By NICK WINGFIELD and KATIE THOMAS
New York Times
OCT. 27, 2017



The pharmacy market, with huge amounts of consumer spending and frustrating inefficiencies, could be attractive to Amazon. Credit Mario Anzuoni/Reuters
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SEATTLE — With little more than a whiff of Amazon’s interest in a new business, the company can crater the stocks of potential competitors, prompting them to consider bold acquisitions and other drastic measures in response. Just ask companies in the home improvement, meal-kit and grocery businesses.

The latest category alarmed by the specter of competition from Amazon is the pharmacy market. With huge amounts of consumer spending and frustrating inefficiencies, it is the type of business that invariably attracts Amazon’s attention. CVS Health is now in talks to acquire Aetna, one of the nation’s largest health insurance providers, a move considered to be partly a reaction to the footsteps of Amazon.

The likelihood of Amazon’s eventually getting into the pharmacy business is high, several analysts and a former employee said. But it is not clear when it will make that move or how aggressive it intends to be.

The near-term threat may be somewhat overstated. Amazon has received wholesale pharmacy licenses in at least a dozen states, as The St. Louis Post-Dispatch reported on Thursday. But the licenses permit the company to sell other kinds of products too. In Connecticut, for example, the license is for “wholesale of drugs, cosmetics and medical devices,” while in Louisiana it was granted to a “drug or device distributor.”

Brian Tanquilut, an analyst for Jefferies, noted that the company acquired many of the wholesale pharmacy licenses between fall of last year and early this year, around when the company started selling medical supplies to businesses. “It’s not evidence of a retail entry into the pharmacy business,” he said.

An Amazon spokeswoman, Lori Torgerson, refused to comment on “rumors or speculation” about Amazon entering the pharmacy business, but she shared a statement that suggested other motivations for the paperwork. “Wholesale licenses are required for Amazon Business to sell professional-use only medical devices in certain states,” she said.

There is little doubt, though, that Amazon is interested in at least some aspects of the pharmacy business. Brittain Ladd, a supply chain consultant who worked at Amazon until earlier this year on groceries and other initiatives, said he participated in discussions about how Amazon could enter the category, including through acquisitions.

“The pharmacy business was always a topic of interest when I was with Amazon, and there was a sincere desire on the part of Amazon to create a better customer experience across pharmacy and health care as a whole,” he said.

While Mr. Ladd said he isn’t privy to the company’s current strategy, he believes existing pharmacy companies are right to be worried. “My advice is that executives at pharmaceutical companies should crush all assumptions when it comes to Amazon and their ability to enter, innovate and reimagine the pharmacy business and health care,” he said.

If Amazon decides to enter the market, it could take a variety of avenues, analysts said.

The easiest way in would be to set up a mail-order pharmacy that focused on price-sensitive customers without health insurance or who have high-deductible plans that require them to pay for some drug costs upfront. To do this, Amazon would need retail pharmacy licenses in every state — a hurdle, certainly, but not an insurmountable one, the analysts said.

Amazon Is Trying to Do (and Sell) Everything

The company’s $13.4 billion deal for Whole Foods is the latest signal of Amazon’s ambitions to have a hold on nearly every facet our lives — like the computer servers that power our favorite websites and the food we eat.

“They can at least dip their toe in the water with the cash-pay customers, and learn the business,” said Ana Gupte, an analyst for Leerink Partners.

She said cash-paying customers account for 5 percent to 10 percent of the $560 billion prescription drug business.

The idea could prove attractive to customers who already go to Amazon for a wide range of shopping items, from shoes to electronics to diapers. Retailers like Target and Walmart have added pharmacies to bring in extra business for a similar reason. Amazon’s recent acquisition of Whole Foods could also provide a physical location for pharmacies.

“A large part of the infrastructure is already there,” said David Maris, an analyst for Wells Fargo.

In a call with analysts this week, Timothy C. Wentworth, the chief executive of the pharmacy-benefit manager Express Scripts, indicated a willingness to work with Amazon to reach these cash-paying customers. “We certainly see that as something where if they wanted to move into a space, we could be a very natural collaborator,” he said.

If Amazon wanted to go bigger, Ms. Gupte and others said, it could sell to insured customers and even serve as a pharmacy-benefit manager, overseeing drug coverage for people on behalf of insurers and large employers.

This would be far more complex. It would likely require Amazon to either acquire a pharmacy-benefit manager or enter into a partnership with an existing one. Expanding the pharmacy business without the aid of a major pharmacy-benefit manager would be tough, because the benefit managers serve as gatekeepers to insured patients, deciding which pharmacies they can and cannot use. The benefit managers also operate their own mail-order pharmacies, which might make them less willing to accommodate Amazon.

Some said they expect that if Amazon chooses to enter the health care business, it would do so in a big way. The company could attempt to provide comprehensive services to patients, doctors and others, far beyond selling drugs.

Nadina J. Rosier, the health and group benefits pharmacy practice leader at Willis Towers Watson, said other areas the company could explore include offering virtual doctor consults, or using the Amazon Echo, its voice-controlled smart device, for health care applications.

No matter the short-term steps Amazon is taking, Ms. Rosier said, her research has demonstrated that it is “clearly looking to revolutionize how health care is delivered in some way.”

But while Amazon has a track record for upending major industries, from books to groceries, she said health care is complicated and there would be intense pressure to get it right. “It is just a sensitive topic,” she said. “We don’t have as much scrutiny of how much you paid for your jeans, or your shoes.”

Follow Nick Wingfield on Twitter @nickwingfield

A version of this article appears in print on October 28, 2017, on Page B1 of the New York edition with the headline: With a Look By Amazon, Drug Firms Shudder. Order Reprints| Today's Paper| Subscribe

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