Originally Posted by NY Times

September 22, 2006
News Analysis
Relief for Some but Maybe Not Many in Wal-Mart Plan for $4 Generic Drugs
By MICHAEL BARBARO and REED ABELSON

At first glance, Wal-Mart’s plan to sharply cut the cost of generic drugs, to $4, seems like a signal event in American health care. It could make scores of treatments affordable to the uninsured, reduce the burden on Medicaid and bring competitive pricing to the pharmacy industry.

Even company critics have praised the plan, conceding that it represents a case of the giant retailer using its size and ability to wring out costs to improve the lives of regular Americans.

But a close examination of the program, with details confirmed by the company yesterday, suggests that its impact could be blunted by several factors.

The plan, which is said to cover 300 drugs, includes only about 124 separate medicines in various dosages, like 12 versions of the popular antibiotic amoxicillin. It leaves out some popular drugs altogether, like the generic version of the cholesterol-lowering treatment Zocor.

And while uninsured people should benefit from the program, those with insurance may save only a dollar or so, making a trip to Wal-Mart not worth their while, analysts said. In Florida, where the program will have its debut, most people on Medicaid pay nothing and may have little incentive to shop around for cheaper prescription drugs.

“It is not as significant as it first seems, in our opinion,” said Joseph Agnese, an analyst at Standard & Poor’s, who expressed surprise at investors’ reaction to the Wal-Mart announcement, which sent shares of its competitors CVS and Walgreen down sharply yesterday.

As it has for dozens of consumer products, Wal-Mart reduced prices of generic prescription drugs by attacking the few remaining pockets of inefficiency in its operations. For example, it cut out third-party distributors that stood between the chain and drug manufacturers.

“There is a huge profit margin in the generics” for the middlemen like pharmacy benefit managers, the distributors and the pharmacies themselves, said Patricia Wilson of Associates & Wilson, a Rosemont, Pa., health care consulting firm. Wal-Mart appears to be taking some of those profits from the traditional middlemen to lower the prices it is charging for these generic drugs.

The company also introduced rapid, automated machines into its pharmacy distribution centers that had long relied on workers to fill orders. In doing so, Wal-Mart reduced the amount of time that costly drugs sat in warehouses, rather than on store shelves where they could create revenue. “It is not glamorous,” said Bill Simon, an executive vice president at Wal-Mart. “It’s pennies at a time.”

Wal-Mart said that by covering one-fifth of the generic drugs it prescribes at its more than 3,000 United States pharmacies, the new program would make it possible for thousands of people to buy drugs they either cannot afford or currently ration, sometimes by cutting pills in half, to cut costs.

Under the plan, which will begin in the Tampa, Fla., area — and the company says will eventually expand to the rest of the country beginning next year — the $4 fee charged by Wal-Mart will be paid by a combination of consumers, insurance companies and the federal government, depending on a person’s health coverage. On average, generic drugs are now sold at retail for $10 to $30 for a 30-day supply.

An insured customer will not pay more than $4, no matter what the co-payment is, the company said. Wal-Mart would bill the insurer for the difference if the co-payment was below $4. Customers whose co-payment is above $4 are unlikely to use insurance, but pay for the drug out of pocket. Where required, Medicaid users would still pay a small co-payment for a prescription drug, with the government billed the balance. In the past, Wal-Mart might have billed the government significantly more than $4 for a generic drug. “It’s a tremendous savings for state Medicaid,” said Mr. Simon, the Wal-Mart executive.

But Christa Calamas, secretary of the Florida Agency for Health Care Administration, said the state would probably save money only on those Medicaid consumers who already fill prescriptions at Wal-Mart. Since most Florida Medicaid users pay nothing for their prescriptions, they are likely to choose convenient pharmacy locations over lower prices, experts said.

Wal-Mart said it would not lose money on the low-cost generic drugs — and, in fact, several industry analysts predicted the company’s pharmacy business would benefit from the new plan. Unlike CVS or Walgreen, which rely on prescription sales for most of their revenues, Wal-Mart’s pharmacy business represents less than 10 percent of its total revenue and the company has identified it as an area that needs improvement.

By luring customers of all incomes into the store at least once a month to fill generic drug prescriptions, Wal-Mart could increase overall pharmacy and store sales, these analysts said.

Health care analysts were quick to point out that Wal-Mart has carefully chosen which drugs it will cover — 300 out of roughly 11,000 generic drugs available. Moreover, it is not offering some expensive drugs, like any of the cholesterol-lowering statins, at the $4 price. And some of the drugs covered, like generic ibuprofen, cost very little and may be currently available for less than $4. “They are not losing money on all these products,” said Ms. Wilson, the health care consultant.

But she praised Wal-Mart for bringing attention to the cost savings available from generic drugs, which are significantly less expensive than their branded counterparts. Wal-Mart could also introduce much greater competition to the marketplace by pushing the concept of discounts into what has traditionally been an inefficient market. “People will begin to compare prices,” she said.

Wal-Mart has come under fierce attack for its employee health benefits; critics contend the benefits are too costly, given the typical Wal-Mart worker’s wages, and frequently force employees to rely on state programs or forgo coverage altogether. With the lower generic drug prices, which apply to its workers as well as customers, the company appears to be trying to address those concerns.

Still, critics say this plan does little to confront the high costs of health care for the uninsured, including Wal-Mart employees, since they still face the expense of going to a doctor to get a prescription, for example. While the plan is a good first step, “it is clearly as much a public relations effort as a substantive change,” said Ron Pollack, the executive director of Families USA, a Washington consumer group that has often criticized Wal-Mart’s health care offerings.

Wal-Mart’s chief executive, H. Lee Scott Jr., said that “competition and market forces have been absent from our health care system, and that has hurt working families tremendously.” The company, he added, is “excited to take the lead in doing what we do best — driving costs out of the system — and passing those savings to our customers and associates,” as Wal-Mart refers to its employees.