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Clinical Laboratories and Pathology Groups

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Bankruptcies and Store Closings Are Signs of Tough Times Ahead for US Retail Pharmacy Chains

Plans by several national retail pharmacy chains to expand primary care services and even some clinical laboratory test offerings may be delayed because of financial woes

Times are tough for the nation’s retail pharmacy chains. Rite Aid Corporation, headquartered in Philadelphia, closed 25 stores this year and has now filed for bankruptcy. In a press release, the retail pharmacy company announced it has “initiated a voluntary-court supervised process under Chapter 11 of the US Bankruptcy Code,” and that it plans to “significantly reduce the company’s debt” and “resolve litigation claims in an equitable manner.”

Rite Aid may eventually close 400 to 500 of its 2,100 stores, Forbes reported.

Meanwhile, other retail pharmacy chains are struggling as well. CVS Health, headquartered in Woonsocket, Rhode Island, and Walgreens Boots Alliance of Deerfield, Illinois, are each closing hundreds of stores, according to the Daily Mail.

They are each experiencing problems with labor costs, theft, being disintermediated for prescriptions by pharmacy benefit managers (PBMs), and probably building too many stores in most markets.

This is a significant development, in the sense that Walgreens, CVS, and Walmart are each working to open and operate primary care clinics in their stores. This is a way to offset the loss of filling prescriptions, which has migrated to PBMs. Primary care clinics are important to the revenue of local clinical laboratories, but retail pharmacy chains do not yet operate enough primary care clinics in their retail pharmacies to be a major influence on the lab testing marketplace.

Jeffrey Stein

“With the support of our lenders, we look forward to strengthening our financial foundation, advancing our transformation initiatives, and accelerating the execution of our turnaround strategy,” said Jeffrey Stein (above), Rite Aid’s CEO/Chief Restructuring Officer, in a press release. Clinical laboratory leaders may want to closely monitor the activities of the retail pharmacies in their areas. (Photo copyright: Rite Aid.)

Multiple Pharmacy Companies at Financial Risk

Rite Aid Corporation (NYSE: RAD) confirmed it continues to operate its retail and online platforms and has received from lenders $3.45 billion in financing to support the company through the bankruptcy process. 

However, according to the Associated Press (AP), Rite Aid has experienced “annual losses for several years” and “faces financial risk from lawsuits over opioid prescriptions,” adding that the company reported total debts of $8.6 billion.

Additionally, the US Department of Justice (DOJ) filed a complaint “alleging that Rite Aid knowingly filled unlawful prescriptions for controlled substances,” explained a DOJ press release.

Rite Aid is not the only retail pharmacy brand dealing with unwelcome developments. Fortune reported last year that Walgreens and CVS paid a combined $10 billion to 12 states for “involvement in the opioid epidemic.”

Walgreens intends to close 150 US and 300 United Kingdom locations, its former Chief Financial Officer James Kehoe shared in a third quarter 2023 earnings call transcribed by Motley Fool.

And in a news release, CVS announced plans to close 900 stores between 2022 and 2024.

Pharmacy Companies’ Investment in Primary Care 

Though they are experiencing difficulties on the retail side, Walgreens and CVS have significantly invested in primary care.

In “Walgreens Continues Expansion into Primary Care as VillageMD Acquires Starling Physicians Group with 30 Locations in Connecticut,” we covered how Walgreens’ VillageMD primary care clinics business was expanding its footprint by acquiring Starling Physicians, a multi-specialty physicians group with 30 locations in Connecticut.

In that same ebrief, we reported on CVS’ acquisition of Oak Street Health, a Chicago-based primary care company, for $10.6 billion. CVS plans to have more than 300 healthcare centers by 2026.

“We looked at our business, and we said, ‘We’re seeing an aging population.’ We know people don’t have access to primary care. We know that value-based care is where it’s going. We know that there’s been a renaissance in home (care). So that’s kind of how we approached our acquisitions,” Karen Lynch, CVS Chief Executive Officer told Fortune.

Other Challenges to Retail Pharmacies

It could be that these major pharmacy chains are hoping entry into primary care will offset the loss of sales from prescriptions that have migrated to PBM organizations.

In addition to reimbursement challenges, retail pharmacies are reportedly experiencing:

  • High labor costs,
  • Competition from online, bricks-and-mortar, and grocery businesses, and
  • Effects from the work-at-home trend, among other struggles.

“I think there’s a number of challenges which are coming to a head. One, you have ongoing reimbursement pressure. The reimbursement level for drugs continues to decrease, so profit margin on the core part of the business is under pressure,” Rodey Wing, a partner in the health and retail practices of global strategy and management consulting firm Kearney, told Drug Store News.

Additionally, the pharmacy’s drug sales need to be high enough to retain pharmacists, who are difficult to recruit in a post-pandemic market, Drug Store News explained.

And in the retail space where products are displayed, some pharmacies struggle to compete with Amazon on convenience and with “dollar” stores on price. And with more people working from home, retail pharmacies are seeing less foot traffic, Drug Store News noted. 

Retail pharmacy companies also have competition from pharmacies conveniently situated in grocery and big-box stores, Forbes reported. These include: 

Walmart, for its part, reduced operating hours of pharmacies at more than 4,500 sites, Daily Mail reported.

Thus, medical laboratory leaders would be wise to keep an eye on market changes in their local retail pharmacies. Some locations are equipped with clinical laboratory services and a closure could give local labs an opportunity to reach out to patients and physicians who need access to a new testing provider.

—Donna Marie Pocius

Related Information:

Rite Aid Takes Steps to Accelerate Transformation and Position Company for Long-Term Success    

Drugstore Downsizing: CVS, Walgreens, and Rite Aid to Close Nearly 1,500 Stores

Pharmacy Chain Rite Aid Files for Bankruptcy Amid Declining Sales and Opioid Lawsuits

US Files Complaint Alleging Rite Aid Dispensed Controlled Substances in Violation of the False Claim Act and the Controlled Substances Act

Rite Aid Files for Bankruptcy in the Face of Massive Debts and ‘Potentially Significant’ Claims for Role in the Opioid Epidemic

Walgreens Boots Alliance Q3 2023 Earnings Call

CVS Health Announces Steps to Accelerate Omnichannel Health Strategy

CVS CEO Sees Changes Coming ‘Faster than a Freight Train’ for Medicare. She’s Betting Billions She Can Build a New American Healthcare System

Threats and Opportunities Facing Retail Pharmacy

As CVS Says It Will Close 900 Stores, Here Are Three More Big Pharmacy Chains Which Are Shutting Locations and Cutting Hours

Walgreens Continues Expansion into Primary Care as VillageMD Acquires Starling Physicians Group with 30 Locations in Connecticut

Walmart to Open 4,000 Healthcare ‘Supercenters’ by 2029 That Include ‘Comprehensive’ Clinical Laboratory Services

With the majority of Americans living just a few miles from a Walmart, how might independent clinical laboratories compete?

Retail giant Walmart (NYSE:WMT) plans to install 4,000 primary care “supercenters” in stores by 2029 that will include clinical laboratory testing services. This is on top of the dozens of Walmart Health locations already in operation in Georgia, Florida, Arkansas, Illinois, and Texas.

Clinical laboratories already have growing competition in the healthcare marketplace from pharmacy chains CVS (NYSE:CVS), Walgreens (NASDAQ:WBA), and Rite Aid (NYSE:RAD) which have installed in-store healthcare clinics in their retail locations—many of which offer limited, but common, medical laboratory services—as well as from existing Walmart Health locations.

Now, Walmart is poised to become a much bigger healthcare player. According to MedCity News, Walmart is “looking beyond traditional retail clinics as it seeks to create ‘supercenters’ with comprehensive healthcare services.”

Presumably, this includes an expanded menu of clinical laboratory testing services—along with the EKGs, vision care, dental care, and more—that Walmart Health locations currently provide for children and adults.

And though Becker’s Hospital Review reported in March that Walmart’s “plan is in flux,” the major national retailer continues to disrupt healthcare in significant ways.

Not the Average Retail Health Clinic

In “Walmart Health Opens Two Primary Care Clinics at Retail Supercenters in Chicago with Plans to Open Seven Florida Locations in 2021,” Dark Daily covered CNBC’s question, “Is Walmart the future of healthcare?” from its article, “How Walmart Plans to Take Over Health Care.”

We reported that Walmart Health’s list of services included:

  • Primary care,
  • Dental,
  • Counseling,
  • Clinical laboratory testing,
  • X-rays,
  • Health screening,
  • Optometry,
  • Hearing,
  • Fitness and nutrition, and
  • Health insurance education and enrollment.

However, the new Walmart Healthcare supercenters differ from Walmart Health clinics and the clinics operated by Walmart’s retail competitors Target, CVS, Walgreens, and Rite Aid.

Those clinics are designed to draw customers into existing retail setting. Walmart has a different goal with its healthcare supercenter concept.

“There’s a big difference between offering healthcare services to drive more people to your store and offering healthcare services because you’re in the healthcare business,” said former President of Health and Wellness for Walmart, Sean Slovenski, during a panel hosted by the American Telemedicine Association. “We’re in healthcare,” he continued, “We’re not in retail healthcare. We’re recruiting physicians in all of these areas and bringing them in.”

Providing Transparency with Clear, Consistent Pricing

In response to consumer demand for transparency, Walmart is taking a different approach to charging patients for healthcare services. The cost of an appointment for primary care is $40 for an adult and $20 for a child. The patient can choose to bill insurance or not, and people without insurance can pay out-of-pocket.

Prices for individual services are equally transparent. Explaining why Walmart is becoming a player in the healthcare industry, Marcus Osborne, Senior Vice President Walmart Health, told Fierce Healthcare, “It’s issues of affordability. That people can’t afford the care they need for themselves and their families. It’s issues of access … That really is the business that we’ve been in. Walmart’s business has been about helping people afford the things they need, getting them in a more accessible, convenient way, and doing it in ways that are simple. Healthcare’s no different in that regard.”

According to STAT, some 35 million Americans were uninsured in 2020. Thus, the idea of transparent pricing and walk-in affordable care should appeal to a sizable market. Walmart is banking on that. Considering that 90% of Americans live within 10 miles of a Walmart, the potential success of the healthcare supercenters becomes clear, Becker’s Hospital Review noted.

Walmart’s Other Healthcare Moves

In addition to opening 20 Walmart Health Centers, and its plans for 4,000 healthcare supercenters, Walmart has made other moves that indicate its intention to disrupt the healthcare industry.

Walmart Insurance Services, for example, partnered with eight payers during the open enrollment period in 2020 to sell its Medicare products. Through a partnership with Clover Health, a Preferred Provider Organization (PPO), and a Health Maintenance Organization (HMO) with a Medicare contract, Walmart made its insurance plans available to 500,000 people in Georgia, Becker’s Hospital Review reported.

“We’re going to have a consumer revolution in retail for point of care,” John Sculley, former Apple CEO and current chairman at RxAdvance (now called nirvanaHealth), told CNBC. “Why? Because if the Walmart tests are successful, and I suspect they will be, people will be able to go in and get these kinds of health services at a lower cost than if they had health insurance.”

“A lot of the opportunity is just about bringing what we’re doing to more people. I think about Walmart Health and what we launched a little over a year ago in Georgia and the impact we’ve seen in the communities where it launched. I think one of the biggest things to do is how do we continue to find ways to make that model work so we can reach more people with it in more communities,” Marcus Osborne (above), Senior Vice President Walmart Health, told Fierce Healthcare. Walmart certainly has experience in disruption. The retailer upended the grocery industry from the moment it entered the market, and it was the first to offer $4 prescriptions, which disrupted long-standing retail relationships consumers had with their pharmacies. Clinical laboratories should realize that Walmart
will likely make similar waves in the healthcare sector. (Photo copyright: Consumer Goods Forum.)

How Will Clinical Laboratories Compete?

Change is constant. Clinical laboratories that cannot adapt to changing market forces are ill-equipped to withstand the coming “consumer revolution.” However, labs that have already begun to plan for more direct-to-consumer interactions will be better positioned to adjust as changes come.

“My goal is that we have done the work on Walmart Health as a model, to really get it to work from a consumer perspective and get it to work in a way that it scales effectively, that we are able to reach more people,” Osborne told Fierce Healthcare.

Clinical laboratory leaders should understand that this trend is being driven by consumer demand for convenience, lower costs, and price transparency. Labs that don’t prepare to address those forces will be left behind as Walmart provides what consumers want.

Dava Stewart

Related Information:

Walmart Opens Second Health Center Offering Clinical Laboratory Tests and Primary Care Services

9 Numbers That Show How Big Walmart’s Role in Healthcare Is

Walmart Divulges Plans for ‘Healthcare Supercenters’

Why Does Walmart Think It Has a Right to Play in Healthcare? Top Health Exec Osborne Explains

The Number of Americans Without Health Insurance Has Been Trending Up. Let’s Turn It Down Again

Former Apple CEO: Walmart’s Healthcare Services Will Cause ‘a Consumer Revolution’

Direct-to-Consumer Lab Test Start-Up EverlyWell Puts Clinical Laboratory Tests on Shelves at CVS and Target

If direct-to-consumer testing continues to attract healthcare consumers and financial investors, medical laboratories could have a new source of revenue

Many have tried but few have found the right formula to offer medical laboratory tests directly to consumers. Direct-to-consumer lab testing as a robust business model has been an elusive goal. But now one entrepreneur wants to crack this market and just attracted $50 million in venture capital to fund her idea!

Outsiders often establish industries. This was the case when Jeff Bezos created Amazon in 1994. The online retailer transformed the way books were sold and, subsequently, established a massive new retail market.

Along the same lines, Julia Taylor Cheek, Founder and CEO of EverlyWell, a well-financed digital health company based in Austin—hopes to build a similarly disruptive business in the clinical laboratory industry.

Cheek is increasing her company’s outreach to consumers by putting some of the company’s direct-to-consumer (DTC) medical tests on store shelves at CVS and Target.

A former consultant and Harvard Business School graduate, Cheek raised $50 million in financing to expand EverlyWell’s digital platform. According to a news release, “Just two full years into operation, EverlyWell is reporting 300% year-over-year customer growth and a world-class consumer Net Promoter Score (NPS).”

Sound familiar? Dark Daily reported last year on Cheek’s appearance on Shark Tank, where she secured $1 million from Lori Greiner, one of the television reality show’s participating entrepreneurs. Ever since then, many in the media have compared Cheek to Theranos founder Elizabeth Holmes. It’s a comparison that Cheek does not appreciate.

“I think it’s a representation of sexism in our space. There are 15 other companies that have popped up in blood testing and you don’t hear anyone comparing Theranos to those male-founded startups,” she told Inc.

However, Dark Daily believes Cheek may be missing one basis for the comparison with Elizabeth Holmes. Holmes intended for Theranos to serve consumers with lab testing, and let consumers order and purchase their own medical laboratory tests. Cheek is talking about the same primary business strategy of letting consumers purchase their own lab tests.

Armed with this additional financing from investors, EverlyWell intends to expand services and develop new partnerships with retail pharmacy chain CVS Health (NYSE:CVS) and for-profit insurance company Humana (NYSE:HUM).

The news release notes, “The company has also expanded its product line to offer 35 panels, including first-to-market tests in fertility, vitamins, peri- and post-menopause, and high-risk HPV. In addition, EverlyWell has launched an end-to-end care model for consumers, now offering an independent physician consult and prescription, if appropriate, for select STDs and Lyme Disease testing. All of this is included in an upfront price before purchase.”

EverlyWell Intent on Bringing Medical Laboratory Tests to Retail

Earlier this year, EverlyWell made nine lab tests available in more than 1,600 Target store locations, MedCity News reported. This may suggest that retailers are intrigued with direct-to-consumer lab testing.

“We didn’t create new tests or technologies. Instead, we’ve built technology that empowers people to get tests more easily. Our medical director works with the labs to create panels that are already validated and clinically relevant and understandable for consumers,” Julia Taylor Cheek (above), Founder and CEO of EverlyWell told Forbes. (Photo copyright: Arnold Wells/Austin Business Journal.)

Cheek reportedly established EverlyWell after becoming disenchanted with medical laboratory tests that she felt were not well explained and too costly under high-deductible health plans.

Just two years on, EverlyWell reports “hundreds of thousands of customers and tens of millions in sales.” The company plans to add additional staff on top of its existing 70 employees in anticipation of the new funding, Austin Business Journal reports.

“We are building a consumer brand, which means we have to be where people shop. We need to be in places like CVS and Target to really allow for broader distribution and name recognition,” Cheek told the Austin American-Statesman.

What Draws People to EverlyWell?

EverlyWell offers home health test kits, priced from $49 to $400 that people can order without a doctor’s prescription and pay for online. Users take their samples (saliva, urine, or a pinprick of blood) with provided lancets and cotton swabs, MedCity News reported.

EverlyWell’s top selling tests are:

  • Food sensitivity-$159;
  • Thyroid function-$159;
  • Metabolism-$89; and
  • Vitamin D deficiency-$99.

EverlyWell says it is “first” in direct-to-consumer tests for:

According to VentureBeat:

  • EverlyWell Test kits come with registration information, instructions, collection tools;
  • Biological samples are sent by consumers to CLIA (Clinical Laboratory Improvement Amendments)-certified labs that partner with EverlyWell;
  • Results are generally completed within 10 days depending on type of test and business volume;
  • A physician reviews the test results;
  • Reports on test results are electronically accessible through smartphone apps and online web dashboards.  

“Lab testing is arguably one of the most important steps in preventing and managing illness but has been largely ignored by digital health companies. EverlyWell is successfully navigating an entrenched industry to offer consumers an opportunity to take charge of their own health,” said Eric Kim, Managing Partner at Goodwater Capital (which led the financing), in the news release

“We’re building the definitive technology-enabled healthcare platform that consumers deserve and have already come to expect in other areas of their lives,” Cheek told VentureBeat. “As high-deductible plans become the norm, consumers are becoming discerning buyers who look for seamless, digitally enabled experiences.”

Learning from EverlyWell

Of course, pathologists and medical laboratory professionals will watch to see if EverlyWell can sustain its rapid rise in popularity with healthcare consumers. In particular, those consumers who prefer DTC testing over traditional clinical laboratory visits and who may be on high-deductible health plans.

The DTC test market represents an opportunity that most clinical laboratories have yet to take seriously. There are many reasons why medical lab managers and pathologists would be taking a “wait and see” attitude. Meanwhile, EverlyWell has $50 million of investors’ money to use to demonstrate the financial viability of its strategy to encourage consumers to purchase their own clinical laboratory tests—and even collect their own specimens at home!

—Donna Marie Pocius

Related Information:

EverlyWell raises $50 Million in Funding to Accelerate Digitally Enabled Consumer Lab Testing Platform

This Entrepreneur Wants to Change How You Get Blood Tests (and Make You Forget About Theranos)

Direct-to-Consumer Lab Testing Start-up EverlyWell Raises $50 Million

How This Female Founder is Democratizing the Healthcare Industry

EverlyWell $50 Million Funding to Put Test Kits in More Stores

Austin Health Tech Firm EverlyWell Lands $50 Million for Expansion

EverlyWell Raises $50 Million for At-Home Medical Tests

Direct-to-consumer Clinical Laboratory Test Developer EverlyWell Receives $1 Million in Funding from Shark Tank Investor

Innovations in Microsampling Blood Technology Mean More Patients Can Have Blood Tests at Home and Clinical Laboratories May Advance Toward Precision Medicine Goals

Walmart Health Plan Praised as Affordable, Superior Option to Obamacare Exchange Coverage While Offering Expanded Provider Networks

Yet financial pressures on insurers continue to increase premiums and potentially squeeze reimbursement rates for clinical laboratories and pathology groups

Walmart shoppers expect to find low prices on the retailer’s shelves, but the discounter’s full-time employees may be surprised to learn their company healthcare plan is also a low-cost leader. This is a significant finding and is significant for pathologists and clinical lab managers because the Walmart health benefit plan includes an expanded provider network, at a premium that is about half of the subsidized rate for a comparable health plan at Healthcare.gov.

A Washington Examiner analysis comparing Walmart’s employee health insurance program with Obamacare—more formerly referred to as the Patient Protection and Affordable Care Act (PPACA) or simply the Affordable Care Act (ACA)—found that “Walmart’s plan is more affordable and provides significantly better access to high-quality medical care than Obamacare.”

The report also noted that Walmart’s participation in a national healthcare network means employees typically choose from a list of participating providers and high-profile hospitals that dwarfs the number of options on Obamacare exchanges. (more…)

Gen Y Entrepreneurs Launch Oscar, a Consumer-Friendly Health Insurance Company in Bid to Disrupt Traditional Health Insurers

In New York City, innovative clinical laboratories have the opportunity to become a network provider for the region’s newest health insurance company

Three Generation Y entrepreneurs are ready to take on traditional health insurers with their own innovative health insurance company. They claim their novel start-up can better meet the new consumer expectations and behaviors within the insurance industry. If correct, their venture could disrupt the post-Obamacare insurance world.

Game-changing Health Insurance Company?

The Gen Y trio is made up of Josh Kushner, Kevin Namezi, and Mario Schlosser. They recently launched Oscar Health Insurance, based in New York. Kushner is the founder of the tech investment firm Thrive Capital. Kevin Nazemi, Oscar’s president, is a former director of healthcare for Microsoft Corp. (NASDAQ: MSFT). Mario Schlosser is a former McKinsey & Company computer scientist. (more…)

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