What If The Medco Acquisition Doesn’t Happen?

First, I believe that the deal will happen without a doubt especially with the new specialty market share numbers from Adam Fein. While I understand the concerns of the independent pharmacies, I both disagree with them, and I don’t think that the FTC is focused on business protection but is looking at consumers.

That being said, the markets are still discounting the Medco stock which means they think there is some perceived risk. With the shareholder votes at both companies tomorrow, it got me thinking about what would happen if the deal didn’t happen.

If it didn’t happen, you’d have a much smaller Medco. They’ve lost United Healthcare, FEP, CALpers, BCBSNC, and I’m sure others. I’m sure you’d also have some change in the team with people’s resumes out in a tight healthcare executive labor market. You’d have a lot of clients wondering what they would do next. I’m also not sure if David would stay and his team has been together for a while so some of them would likely follow him. At the same time, I think Express Scripts would end up in good shape. They’ve paralyzed one of their big competitors for a year while they’ve continued several projects.

Medco would have to come out swinging in my mind. They would have to look at growth through acquisition putting several companies in play. They might also look at expanding beyond just the core PBM model which I think was always David’s perspective. Perhaps disease management or ACOs or exchanges or technology or maybe try to go vertical by looking at pharma or a wholesaler. I would think companies like IMS or inVentiv would also be interesting.

I’m not sure the FTC would disrupt the acquisition, but I did wonder if someone would try to be the spoiler like Express Scripts tried with the CVS acquisition of Caremark. I’m not sure who could do that but a United Healthcare could pull it off to support their services growth strategy with Optum. Or, Walgreens could take action to counteract their dispute with Express Scripts and follow the CVS Caremark success.

Interesting times.

[Note: I do own stock in many of the companies mentioned here.]