Shrewd. Unfair. Exclusionary. Monopolistic.
These are some adjectives competitors and regulators use to describe the corporate strategy of Surescripts, the company that runs the nation’s largest e-prescribing network.
"They're clearly a very consequential business," Michael Abrams, partner at Numerof & Associates, told Healthcare Dive. But "as an organization, being the biggest network provider, they are really helping to address a critical flaw in the architecture of our healthcare system’s infrastructure."
By the numbers
E-prescribing has surged over the past decade, spurred in part by federal incentives, an emphasis on reducing drug abuse and fraud and increasing interoperability. Prescribing inaccuracy costs an estimated $300 billion annually and medical errors are the third leading cause of deaths in the U.S., according to HHS.
Arlington, Virginia-based Surescripts provides real-time benefits check, specialty medication enrollment and prior authorization products, along with a record locator and exchange allowing physicians to electronically ask for a patient's health records from providers in the same system.
Its products promote interoperability and price transparency at the point of care, experts say. Taken in tandem with increases in value-based payment arrangements and rising consumerism, the technology could ameliorate myriad problems facing the health IT industry, though some warn it won't solve macro issues on its own.
CEO Tom Skelton is not modest about how he sees the 18-year-old company, created and owned by CVS Health (parent company of Aetna and pharmacy benefit manager Caremark), Cigna (which owns PBM Express Scripts) and pharmacy groups.
"I think what we're doing in the prescribing workflow is groundbreaking," Skelton, who joined the company in 2014, told Healthcare Dive. "This is going in at the point in time my provider is selecting a medication for me, understanding exactly what my benefits cover, understanding exactly what my co-pay looks like, understanding exactly what medication alternatives are and doing it with the background of my medication history."
The company partners with virtually all EHR vendors, PBMs, pharmacies and clinicians, plus a growing number of specialty pharmacies, payers and long-term and post-acute care organizations.
But it's also had the consequence of limiting growth and access in the space. While health tech startups are popping up like weeds into other markets, Surescripts' market dominance has made the e-prescribing sector relatively stagnant, according to analysts.
"I don't think there's much innovation left," Jefferies analyst Brian Tanquilut told Healthcare Dive. "Now it's all about maximizing adoption. We're not seeing new players come into this space."
The Federal Trade Commission sued Surescripts in April over alleged anticompetitive corporate practices to maintain its 95% market share in the e-prescribing markets for routing orders from providers to pharmacies and for determining patient eligibility for coverage of the drugs.
Alleged tactics include a pricing policy rewarding companies for remaining loyal to Surescripts, requiring long-term exclusivity from almost all of its customers, pressuring EHR vendor Allscripts into keeping its business and entering into an agreement prohibiting a competitor, RelayHealth, from joining the routing market for six years in 2003 — all to the detriment of consumers, FTC said.
Though Surescripts filed a motion to dismiss the case, the suit is still ongoing.
Surescripts, which has an estimated annual revenue of $47.5 million, is also engaged in a byzantine fight with Amazon. Earlier this year, Surescripts ousted third-party data company ReMyHealth from its network. ReMy contracts with Amazon's prescription drug delivery subsidiary, PillPack, so its expulsion spurred speculation the move was meant to stymie Amazon's foray into healthcare.
"There's a reason Surescripts exists: It's helped increase the percentage of e-prescribing across the country," Tanquilut said. "But at the same time, from a drug perspective, it's certainly had the effect of moderating Amazon's pace of entry into the prescription drug world."
But despite the year's controversy, Skelton contends he and the company are unbothered. "Our focus remains on serving the folks that make up the Surescripts Network Alliance, staying focused on improvement and accuracy," Skelton said.
And it has certainly moved the needle on the market. It’s a “great example of a technology company that’s making a meaningful difference in the quality and cost of healthcare,” Abrams said — ruffling feathers all the way.