Even as the federal government flexes its muscles and threatens more regulation of pharmacy benefit managers, companies like CVS(CVS) - Get Report , Express Scripts (ESRX) and UnitedHealth(UNH) - Get Report have not suffered much in the market.
CVS, which has a market cap of $103.57 billion, has been steadily climbing in share price since February. It was trading at around $96 per share midday Tuesday. Express Scripts, which has a market cap of $47.68 billion, has steadily improved since bottoming out at $67.11 in February and was trading at around $75 midday Tuesday, while UnitedHealth, which has a market cap of $127.17 billion, was trading at around $134 per share, up from $109.23 in January.
"My view is the government getting involved with drug pricing right now is really just noise around the election," analyst Steven Halper of FBR Capital Markets said in a phone interview.
Despite negative sentiment toward some of these companies effect on drug prices, PBMs remain successful businesses. That could change, though, after the November election."Nothing substantive is going to impact industry fundamentals in the short term," Halper said. "Longer term it will depend on who is sitting in Congress and the White House."
The government's most recent actions, announced May 11, include a Department of Justice investigation into drug companies' contracts with pharmacy benefit managers, or PBMs, which negotiate drug prices on behalf of insurance companies. The companies being investigated are Johnson & Johnson(JNJ) - Get Report , Merck(MRK) - Get Report and Endo International(E) - Get Report .
According to David Balto, the former policy director of the Federal Trade Commission, these drug companies are less affected by the investigation than PBMs, even though the PBMs have yet to release any information on whether they too are being investigated. "Choice, transparency and a lack of complicit interest, on all three of these interests PBMs receive a failing grade," Balto, who is currently an antitrust lawyer in Washington, D.C. said in a phone interview. "They're able to make a remarkable amount of money for basically just transferring money."
Lawyer Brian Dickerson of FisherBroyles agreed, and added that the recent influx of M&A activity in the pharmacy and PBM industry isn't healthy for competition. "I think that mergers are hurting not only the pharmacies but also the competition in general," he said in an interview.
He added that mergers in one space - health insurers, pharmacy benefit managers or pharmacies themselves, have an impact on the others. When two health plans consolidate, for example, they're no longer using two separate PBMs. This causes the PBMs to consolidate, becoming larger and taking business away from traditional pharmacies.
How the concerns about PBMs will play out after the election will likely depend on who how control of the White House and Congress is decided in November.
According to Halper, Republicans tend to be more friendly than Democrats when it comes to drug companies. He added that investors should "stay tuned" to see what antitrust actions the FTC will take in coming months. "The FTC has been pretty active in declining mergers outside of healthcare," he said. "In the coming months, I think you would expect the same sort of environment, but those things can change at the end of a term or beginning of a new term."
The FTC is already looking into insurer Anthem's(ANTM) - Get Report $54.2 billion acquisition of Cigna(CI) - Get Report . Whether or not this merger is approved will have an effect on Anthem's PBM, Express Scripts, and whether its contract gets renewed in 2019.
"We've been saying that given the public disclosure, there's a pretty good chance that Express Scripts will lose the contract or will renew at substantially different terms," Halper said. "It's hard to find the silver lining for Express."
"It's make more sense to me that if Anthem-Cigna deal goes through, they could look to build out organically," analyst Sarah James of Wedbush Securities said in an interview.
David Larsen of Leerink Partners wrote in a May 31 note that Cigna has been on a hiring spree, adding executives to its PBM division. "One of our specialists highlighted that Cigna continues to ramp up its hiring efforts around its PBM, and many legacy Medco executives appear to be joining Cigna," Larsen wrote in a note.
He added that this could signal that Anthem is poised to break up with Express Scripts once its contract expires in 2019. "Without knowing specifically what positions, I think it's hard to read into it," James said. "I've seen it play out both ways."
Walgreens'(WBA) - Get Report acquisition of Rite Aid(RAD) - Get Report could also be under federal scrutiny in the coming months. "Rite Aid trades at a 17% discount on its offer price," Halper said. "There's still some skepticism on both of those companies completing this transaction."
This acquisition will likely affect PBMs, he added. "The PBMs certainly don't want to see Walgreens get bigger," according to Halper. "But I don't think they're voicing their opinion that loudly for regulators.