Interview, Fireside Chat
a16z Podcast | On Recent Consolidation in the Healthcare Industry
- The Walmart-Humana transaction signals the start of increased vertical integration across the healthcare value chain, expected to lower costs and create value by aligning more stakeholders.
- Local retailers like Walmart and CVS are positioned to derive greater value than the Amazon-JPMorgan-Berkshire consortium due to healthcare's nature as a local business and the geographic dispersion of employers.
- While Amazon may view opaque PBM margins as an opportunity, the consensus is that the company will likely build capabilities in-house rather than acquire an existing PBM or major properties like CVS and Aetna, despite the potential for surprise.
- Amazon's current partnership is characterized as a learning and hiring initiative rather than an immediate acquisition strategy, with no comparable "marquee property" currently identified in the sector.
- Market entrants, particularly startups, may find success by targeting the "digital therapeutic PBM" niche to avoid direct competition with established incumbents.
- Both employers and consolidating entities must achieve increased efficiencies to extract margins and reduce costs, a necessity driven by the shifting value chain landscape.
- Full vertical integration is anticipated to unlock new technologies previously hindered by transactional frictions associated with dealing with multiple players.
- The emergence of a digital PBM logistics chain specifically for gene therapies, cell therapies, and other advanced medicines is expected, driven by the high current costs and difficult supply chains of these treatments.
- The business case for cell therapies may materialize sooner than expected due to their prohibitive costs, potentially resulting in a digital PBM model that differs significantly from current specialty pharmaceutical structures.