WAG/RAD: Pressure on generic dispensing margins likely to be much more permanent than guidance implies

Richard

WAG & RAD both recently lowered guidance; both blame falling generic dispensing margins. In each case the companies point to pressures on both sides of the margin equation – rising generic acquisition costs, paired with lower-than-expected reimbursement

Unravelling the relative importance of these two effects is strategically crucial; rising generic acquisition costs are relatively transient; rising reimbursement pressures are more likely to be permanent

Evidence indicates generic acquisition costs played little if any role in reducing companies’ generic margin expectations; this implies falling reimbursement pressures played the major role, and that lower generic dispensing margins are here to stay

The companies make 3 arguments regarding the generic acquisition cost trend: 1) acquisition costs grew at a surprising rate on ‘existing’ products; 2) acquisition costs on newly launched generics fell more slowly than normal; and 3) newly launched generics are being made by fewer manufacturers than expected

None of these arguments are supported by evidence. On a sales-weighted basis, ‘existing’ product generic acquisition costs indeed experienced major hikes through February 2014, but they remained stable thereafter through the months when the companies issued/confirmed higher guidance (and subsequently lowered it). Also on a sales-weighted basis, acquisition costs of newly launched products fell faster more recently (Nov. 2013 – July 2014) than they did last year. Finally, the number of manufacturers for new generics has been no different than should have been expected given the dollar size of the parent brands, the presence or absence of an OTC version of the parent molecule, and the complexities of manufacturing any given new generic

By simple process of elimination this argues that reimbursement pressures are likely to be the major cause of falling generic dispensing margins at retail. The companies acknowledge the trend to narrow networks has played some role in reduced reimbursement; we would argue that narrowing of networks appears to have played a major role, will continue for some time, and will result in steady additional pressure on generic margins. As context, consider that REAL retail pharmacy dispensing margins have grown faster than real pharmaceutical prices since at least 2001, despite the fact that there are no fewer outlets now than in 2001

Unmentioned as a driver of lowered guidance is the shift toward reimbursing pharmacies on the basis of NADAC (which is likely to result in lower generic margins than reimbursements based on AWP). NADAC became available to all US retail pharmacies in April of this year, meaning 2014 has been the first negotiating season (for 2015 benefits) in which payors could reasonably be expected to ask retailers for NADAC-based contracts

For our full research notes, please visit our published research site

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