Kristoffer Tripplaar/Sipa USA via AP Images
Some of the most heated policy debates in D.C. these days involve the use of big data to surveil people’s habits. This is usually ascribed to powerful firms like Google and Meta. But across the economy, dominant firms are copying the business methods of Big Tech, and causing similar if not more widespread damage through predatory practices. Indeed, if you want to know the perils of big data and dominant corporate power, just ask your local pharmacist.
Recently, the customers of one local pharmacist got solicitation letters from a competitive specialty pharmacy named Genoa. They got these letters the day before UnitedHealthcare—one of the largest health insurers in the country—stopped allowing its customers to get medicine from this independent pharmacist. Here’s the punch line: Genoa is owned by UnitedHealthcare, having been purchased by its Optum subsidiary in 2019. So UnitedHealthcare can use its data and its power over customers to steer patients to its suppliers and kill local pharmacies, even when communities rely on them for all sorts of medical care.
What’s even more galling is that UnitedHealthcare is trying to get bigger so it can conduct even more surveillance. Last year, UnitedHealthcare proposed buying Change Healthcare, which is the largest repository of medical claims data in America. Fortunately, the Department of Justice Antitrust Division, which is trying to revive anti-merger law after 40 years of dormancy, sued the companies to block the deal. Now it’s up to district court judge Carl Nichols whether to allow this dominant firm to get even more powerful.
Despite being vital providers, local pharmacists are under attack from massive vertically and horizontally merged companies.
The fate of America’s local pharmacists may hang in the balance. Independently owned community pharmacies are small businesses that represent over one-third of all retail pharmacies. In urban and rural settings alike, they are some of the most accessible health care providers. In addition to dispensing prescribed drugs and supplements, independent community pharmacies provide vaccines, health assessment services, and diabetes self-management education. They are usually lower-cost than chains, and more connected to local communities.
Despite being vital providers, they are under attack from massive vertically and horizontally merged companies. In the past five years, every dominant pharmacy benefit manager—middlemen that pharmacists deal with for their reimbursements—has merged with a dominant insurance company: Aetna/CVS, UnitedHealthcare/Optum, and Cigna/Express Scripts. For far too long, these mergers have gone unchecked, giving these companies increasing power over independent pharmacies.
So what is the specific problem with the Change merger? On the pharmacy side of the merger, Change Healthcare’s eRx network contains an inordinate amount of data that has both medical and pharmaceutical implications for insurability and health care utilization. It also contains sensitive information about UnitedHealthcare’s competitors. In pharmacy parlance, eRx is a “switch”: It possesses data that gives a comprehensive view of patients’ health care claims, bills, payments, and pharmacy interactions across nearly all insurers. It also contains competitive information on pharmacy benefit managers, insurers, patients, and pharmacies that compete at various levels with the UnitedHealthcare vertical. Change’s eRx connects about 59,000 pharmacies and processes more than 1.5 billion claims transactions a year. It also handles millions of e-prescribing transactions a month, connecting pharmacies’ pharmacy management service vendors to pharmacy benefit managers.
History has shown that UnitedHealthcare/Optum will use this information against its competitors to create unequal bargaining positions, steer patients, reduce access, and increase consumer price points. Acquisitions such as these should be opportunities to decrease end prices to consumers. But as we have seen in health care acquisitions time and time again, the merged firms squander the opportunities and muscle out competition, and consumer price points suffer as a result. Ask yourself: Are you now on a high-deductible plan? Does your employer pay more every year to insure you? Have your prescription drugs become less affordable? Do you have fewer choices on where to get your care or your medications? Do you have to fill your prescription at the pharmacy of your insurer’s choosing? For most of us, unfortunately, the answers are “yes” to all of the above.
This is all due to consolidation and the lack of consideration of non-price effects of mergers. By gaining access to eRx, UnitedHealthcare will have access to: the data of its insurer competitors Aetna, Cigna, Anthem, Humana, and Blue Cross Blue Shield; the data of PBM competitors CVS Caremark, Express Scripts, Ingenio, Humana Pharmacy Solutions, and Prime Therapeutics; and the data from retail and mail-order pharmacies, including independent pharmacies. It will be a 360-degree view of the marketplace, which will enable them to target the patients who will make them the most money while excluding others.
UnitedHealthcare responded to the Justice Department lawsuit by saying it is willing to sell ClaimsXten, its claims payment solution for businesses. UnitedHealthcare also insists that it hasn’t already misused competitor data gleaned from OptumInsight, its existing claims payment solution. While selling ClaimsXten makes sense initially, what will stop UnitedHealth from buying it back a few years later, like what happens in so many transactions where the combined entity is asked to divest an asset? And what do you say to independent community pharmacies about Optum not misusing data? Simply trusting that UnitedHealthcare is “Helping people live healthier lives” doesn’t cut it when its corporate practices are sickening the system that’s designed to keep people well.
We’ve heard promises from large, vertically integrated, dominant firms like UnitedHealthcare seeking to buy up rivals many times. Yet health care seems to get more expensive and difficult to obtain every year. The Department of Justice Antitrust Division, after many years, is finally doing the right thing by saying no more. We hope Judge Nichols will follow suit.
