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Hoey and colleagues noted that Change runs a “switch” that routes claims from pharmacies to insurers and benefits managers. The latter is tasked with dictating which pharmacies patients use, how much they pay at the counter, and reimbursement for such services. The NCPA sees info flowing through these switches as highly valuable and believes placing it in UnitedHealth’s hands will create a “massively unfair advantage.”
“That data will be used to undercut reimbursements and raise fees on independent pharmacies,” Hoey said. “It will be used to steer patients to UHG’s health plan and Optum’s mail-order pharmacy. This merger is a threat to fair competition, independent pharmacies, and patient choice.”
Beyond pharma, Nashville-based, Blackstone Group-backed Change Healthcare offers various solutions in radiology, cardiology and other specialties. Those include medical imaging consulting, enterprise storage solutions, revenue cycle management, data analytics and clinical decision support, according to its website. In April, the American Medical Association voiced concerns that UnitedHealth could use physician reimbursement data from Change’s databases to unfairly steer rate negotiations.
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