Just weeks ago, a looming merger between two major health insurance companies threatened to alter the health insurance market’s competitive landscape. The $54 billion deal between Anthem and Cigna was blocked by a federal judge in early February, on the same grounds as a $37 billion deal between Aetna and Humana that was blocked in January. According to the judges’ rulings, both deals would have reduced competition and increased prices.
Healthcare reimbursement in the U.S. is undergoing a fundamental transformation. The Center for Medicare & Medicaid Services has led this transformation, announcing that 50% of all Medicare payments will shift from fee-for-service to alternative payment models by 2018. Pharmaceuticals have been entirely omitted from these plans, as Medicare is legislatively prevented from negotiating drug prices. Hence, manufacturers and private payers are expected to play a dominant role in determining payment models that reimburse pharmaceutical manufactures for value in the form of patient outcomes, rather than the pills, themselves.