Industry Trends

On March 8, 2018, health insurer Cigna agreed to purchase the largest pharmacy benefit manager (PBM) in the United States, Express Scripts, for $52 billion. This deal is the latest in a wave of payer consolidations that have the potential to reshape the US healthcare.
When this view into 2018 was developed, Senate failures to repeal, replace, or change the Affordable Care Act (ACA) had occurred, and left the market unchanged from a legislative perspective. Regardless, relentless market change before and after the implementation of the ACA has left ACA exchanges in financial trouble, providers facing decreased reimbursement, and consumers with limited access to plans by metropolitan statistical area across the country.
In October 2014, ledipasvir plus sofosbuvir (Harvoni) became available in the United States, providing renewed hope for patients with certain chronic hepatitis C virus (HCV) genotypes.
Disruptive innovation and a growing emphasis on value are reshaping diabetes treatment across the United States. In recent years, as the population of patients with diabetes continues to grow and as the cost of treatment continually rises, pharmacy benefit managers (PBMs) have gone beyond the traditional (ie, progressive formulary tiers, prior authorization, step edits) management techniques by using more aggressive restrictions in an effort to control spending on pharmacy.
The year 2016 saw a “pause” in most market trends as the US presidential election cycle unfolded and Brexit occurred. As we begin 2017 with a new Republican leadership in Washington, DC, led by outsider President Donald Trump, we know that change is imminent throughout all segments of the US market.

The implementation of the Affordable Care Act (ACA) introduced significant changes to the healthcare landscape that have affected patients, providers, and payers.

The United States is the only profit-motivated healthcare system in the world, and perhaps it is no coincidence that this country also has the most expensive healthcare of any nation.

The United States is the only profit-motivated healthcare system in the world, and perhaps it is no coincidence that this country also has the most expensive healthcare of any nation.
Self-funded plan sponsors of commercial insurance health plans include employers, municipality governments, and unions. In many areas, a coalition of plan sponsors work together in partnership to purchase and/or manage healthcare benefits, such as prescription drugs, as a benefit carve-out from their medical benefits.
Many of the 2016 healthcare trends began between 2012 and 2014 and finally emerged more clearly in 2015 for commercially insured populations.
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