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Cannabis Special Coverage

After the Green Rush

The numbers are impressive, to be sure.

Adult-use cannabis shops in Massachusetts posted close to $1.5 billion in sales in 2022, up from $1.33 billion in 2021. Since recreational sales began in late 2018, the total figure is closing in on $4 billion.

That’s a big pie.

The problem, for the hundreds of dispensaries already open and many more at various stages of planning and development, is that each slice of that pie is getting smaller. As a result, prices are crashing, with some products selling for half of what they did a year or two ago.

That’s great for cannabis consumers. For businesses? Not so much.

But it’s not an unexpected development, not is it any sort of crisis, said Michael Kusek, publisher of Different Leaf magazine and one of the nation’s leading experts on the cannabis industry. But it’s certainly a challenge, one that promises to weed out some of the current players.

“You can’t solve the overabundance of product in the marketplace by transferring it to another market,” Kusek told BusinessWest. “You can’t make the product go away, so the price bottoms out. This has happened in every other market, so it’s not a shock.”

It will, however, require business owners to think smarter, focusing on quality, the customer experience, and other ways of differentiating themselves in an increasingly crowded marketplace. And the situation already has municipalities revisiting old concerns about a saturated market.

Northampton, where one of the city’s 12 dispensaries, the Source on Pleasant Street, recently closed, is the most notable case, as its City Council voted 6-3 last month to cap the number of retail cannabis shops at 12 going forward.

At press time, Northampton Mayor Gina-Louise Sciarra said she would not sign off on the cap, but with a two-thirds vote of the City Council needed to overcome any veto, the measure will likely still become law.

“We are not anti-business,” Councilor Marianne LaBarge said before the vote, as reported by the Shoestring. “We have a job, and we have heard from so many people to place a cap.”

Some residents at a hearing days before the vote expressed concerns about the impact of so many cannabis shops on the city’s youth, while councilors like LaBarge said they want to protect existing businesses from being crowded out.

Council President Jim Nash, one of the dissenters, said he favored a cap when recreational cannabis first became legal, but now believes the maturing marketplace is providing a natural cap, as evidenced by the Source’s closing and declining sales at other shops. He argues as much in a recent column in the Daily Hampshire Gazette, co-written with former City Councilor Dennis Bidwell.

“Since when does local government step in to protect the bottom line of existing businesses by excluding the entry of competition?” they wrote. “We don’t do that for beauty salons or pharmacies or anything else. It’s one thing to put a cap in place in the early stages of an industry’s development, before anyone has opened their doors. It’s another thing entirely to enact a cap that would freeze the market where it is, prohibiting further competition.”

What isn’t up for debate is that it’s getting tougher to turn a profit in an industry that’s already taxed about 70% and can’t claim many normal deductions. That reality, plus an ever-more-competitive marketplace, both inside Massachusetts and from surrounding states, is creating an environment that’s not unexpected for those who have followed the industry’s maturation in other states.

“So many people think, ‘if I get a license, I’m going to be a kajillionaire.’ Sorry, that’s not the case. If you’re in it because of the money, it’s going to be a tough road for you.”

People like Meg Sanders, CEO of Canna Provisions in Holyoke and Lee, who was in Colorado when that state, one of two, along with Washington, to pioneer legal adult-use cannabis in 2012, experienced its own ‘green rush,’ with a quickly saturated market causing prices to plummet. What Massachusetts cannabis businesses need to do, she said, is to focus on differentiating themselves in the right ways (see story on page 35).

“I think it’s going to be a painful year, but a necessary year. Honestly, it’s important,” she said. “So many people think, ‘if I get a license, I’m going to be a kajillionaire.’ Sorry, that’s not the case. If you’re in it because of the money, it’s going to be a tough road for you. We believe money is a byproduct, not a goal. We believe in running a good business, a responsible business, serving customers thoughtfully and respectfully and providing an amazing experience with lots of options on the menu. A cannabis purchase should be fun.”

Certainly more fun than selling the product at a time when economic realities in the industry are dramatically shifting.

 

Growth Potential

There’s no doubt that legal cannabis has been a boon to not only sellers, growers, and manufacturers, but to state and local coffers. Massachusetts imposes a 10.75% excise tax on purchases, while recreational cannabis purchases are also subject to the state’s 6.25% sales tax, and most municipalities levy 3% more.

David O’Brien, the president of the Massachusetts Cannabis Business Assoc., recently told the Boston Globe that the industry will remain strong despite its current challenges.

“Legalization has brought about change people can see. You can see it in the tax revenue, in the jobs that have been filled, in the dispensary storefronts that used to be empty, in the old warehouses that now host manufacturing companies — it’s all growth, it’s all progress, and the sky did not fall.”

Michael Kusek

Michael Kusek says the cannabis industry’s tightening profits are a natural evolution that has occurred in other states.

As for those jobs, about 22,000 workers were authorized by the state to work at licensed cannabis facilities as of December, making it an attractive field to enter, Kusek said. “Once they get a little experience under their belt, they’re infinitely more marketable. Head growers are making $100,000 to $120,000 a year.”

The problem, he noted, is that players coming into the market now are dealing with product prices that are much different than when they established their first business plans. And the regulatory hoops remain challenging in many cases, as is the decision of where to locate: in a community with limited licenses that are difficult to secure, or a community with a more laissez-faire approach, but also, as a result, much higher competition?

“I just talked to a couple of lawyers, and they’re not working as many licenses as they were two years ago,” Kusek said, and there could be several reasons for this, foremost being access to capital, which is still limited because most banks won’t lend for cannabis enterprises.

“If they can’t access capital, they’re forced to shoulder the ups and downs of the industry by daily revenues,” he added. “If you open a successful restaurant and want to open a second location, you can go back and get a loan to do that. If you want to open a second cannabis location to sell all this product you have, you can’t easily do it.”

“Regular businesses still get normal deductions, but we can’t deduct anything except the cost of goods. That creates a real challenge for overall profitability and cash flow.”

Meanwhile, cannabis investors in the Northeast are increasingly looking to what Kusek calls “the shiny new object” — New York, where shops started selling legal recreational cannabis just a few weeks ago. “That’s where the capital is going, which starves out the businesses we have here.”

And when capital dries up, it’s the mom-and-pop entrepreneurs that suffer, as well as social-equity candidates.

“The companies that operate in multiple states have more of a cushion; they can continue to roll forward,” Kusek said. “Who’s going to get hurt by this [competition]? People who have been trying to get a license for a long time. This just makes it harder for them if they didn’t get more of a leg up in the beginning.”

Sanders said the businesses that survive, both those currently operating and those just setting up shop, will be those that “hunker down a little bit and are super thoughtful with every dollar.”

“This is a business that has zero deductibility, except the cost of goods,” she added. “We have to be way more careful than any other business going through this recession. Those regular businesses still get normal deductions, but we can’t deduct anything except the cost of goods. That creates a real challenge for overall profitability and cash flow.”

Without examples from other states to consult, Sanders recalled, Colorado was immediately saturated, prices cratered, and the market became what she called “a race to the bottom,” with price trumping everything. “But as things got more sophisticated in Colorado, a lot of good operators started telling compelling stories about why you should spend money with this dispensary rather than that dispensary.”

That’s why she focuses on the stories behind Canna’s products and also on giving back to the communities in which she operates.

“Businesses need to be as lean as possible and as thoughtful as possible, and make sure you’re telling a compelling story about why people should buy your brand.”

 

Legitimate Concerns

In their recent column, Nash and Bidwell argued that public-safety and public-health concerns that motivated discussion about a cap on dispensaries in Northampton five years ago have not come to pass.

“There is, and always will be, an underground market for unregulated, uninspected marijuana. This black market is fraught with crime and suspect product,” they wrote. “The availability of legal marijuana puts a dent in this market, tilting the share of sales toward legal purchase rather than black-market ones. To the extent the market allows, additional regulated cannabis retail outlets will further reduce the use of unregulated, dangerous cannabis.”

And falling prices in legal shops may entice many long-time black-market customers to try different types of strains and products, Kusek said. “As prices come down, people will try and buy more. This is great for consumers; in some circumstances, it costs half of what it did. For consumers, that’s great.”

That’s even more true for medical users, he added, as they tend to be more price-sensitive than recreational users, since they often have to maintain regular usage with finite resources, since insurance won’t cover the product.

“This is still a young market, and consumers are still developing their preferences. It’s only been a couple of years, and people will develop brand loyalty and particular consumption methods, and they will spend their money to get those particular brands or products.”

Kusek agreed with Sanders that product quality is important, especially as consumers are still discovering what they like.

“This is still a young market, and consumers are still developing their preferences,” he told BusinessWest. “It’s only been a couple of years, and people will develop brand loyalty and particular consumption methods, and they will spend their money to get those particular brands or products. That will come over time.”

Kusek also believes the consumer base has room to broaden.

“People become cannabis consumers for a wide variety of reasons. We have a medical market and people for whom cannabis is a significant part of their medical treatment, and you have more people coming into the market and exploring cannabis for treating pain and sleeplessness. Those people are always going to be coming into the market, as well as people who are curious about it.

“I think one of the challenges in cannabis is connecting and finding consumers; with each new market that comes online, you get the people who are curious, or who are coming back to cannabis after not using it for a long time, people whose life circumstances have changed. There will always be new consumers.”

In other words, it may be a tougher business to navigate than when there were only a few dozen shops open in Massachusetts, but it’s still a dynamic field.

As Kusek put it, “it’s never dull, that’s for sure.”

Coronavirus Insurance Special Coverage

At a Premium

The story is a familiar one by now: hospitals across the U.S., hammered by COVID-19, began directing resources toward fighting the pandemic last spring and curtailed elective and non-emergency procedures. Meanwhile, patients, even when sick, stayed away from medical practices out of fear of infection.

As a result, health insurers continued to reap premiums while paying out millions of dollars less in medical claims. Some of the largest companies reported second-quarter earnings about double what they were a year ago. Anthem’s net income soared to $2.3 billion for the second quarter, up from $1.1 billion in 2019, while UnitedHealth reported net income of $6.7 billion, compared to $3.4 billion last year. Humana’s second-quarter net income rose from $940 million in 2019 to $1.8 billion in 2020.

But the issue is a complex one, especially in Massachusetts, where laws governing insurance are different, said Keith Ledoux, vice president of Commercial Line of Business, Sales, Marketing, and Business Development for Health New England, a 166,000-member health plan based in Springfield.

For example, HNE did see lower utilization for medical services among its members in the early months of the pandemic; however, at the same time, it saw an increase in prescription-drug fills as members made sure they had their medications during stay-at-home orders.

“On the pharmaceutical side, we saw a small spike in claims and overall costs starting at the end of March and the beginning of April because we had relaxed our rules on allowing folks to fill prescriptions early, or to get a greater supply,” Ledoux told BusinessWest.

Meanwhile, “after April, on the medical side, we saw a significant reduction in claims, but starting in probably June, we started to see that pick back up — almost back to what we would consider to be somewhat normal.”

At the same time, the pandemic brought about a significant increase in telehealth utilization; through April, HNE had processed 114,000 telehealth visits for its members versus 900 in all of 2019, accounting for $12 million in costs for Health New England.

“One reason that’s so costly for us is that we’re mandated by the government to pay the same rate for telehealth as we would for an in-person visit, and typically telehealth is cheaper than in person,” Ledoux said, adding that future state negotiations will likely alter that formula as telemedicine continues to gain traction in healthcare.

“The silver lining is not the cost, but the behavior shift of so many members embracing the idea of telemedicine, which does broaden your ability to access non-invasive care. There’s definitely an opening for systems to adopt a new approach and potentially increase their revenue stream using telemedicine.”

Massachusetts-based Tufts Health Plan reported that COVID-19 treatment costs were one factor in actually recording a drop in net income between the first six months of 2019 to and the six months of June 2020.

Keith Ledoux

Keith Ledoux

“After April, on the medical side, we saw a significant reduction in claims, but starting in probably June, we started to see that pick back up — almost back to what we would consider to be somewhat normal.”

“Tufts Health Plan proudly serves all segments of the market, regardless of a person’s age or life circumstance,” Chief Financial Officer Umesh Kurpad noted in a statement. “This diversity in our business translates into different financial pressures, such as significantly higher COVID-19 infection rates and treatment costs for our members, particularly those who rely on both Medicare and Medicaid.

“Year-to-date, our earnings were challenging, with the increased costs of COVID-19-related expenses across virtually all of our businesses,” he went on, projecting COVID-19 expenses to reach $220 million for the full year. “The pandemic cost tail is anticipated to be long with the lingering impact of COVID-19 survivors and increased morbidity from deferred care.”

In short, there’s no one trend common among health insurers in a year where they, like all industries, have learned to expect the unexpected.

Appointment Viewing

Another Massachusetts-based insurer, Harvard Pilgrim Health Care, reported little change in second-quarter net income from 2019 ($36.2 million) to 2020 ($40.9 million). It also encouraged members not to avoid medical services they need.

“Now more than ever, our focus remains on the health and well-being of our members and the communities we serve,” President and CEO Michael Carson said. “Many people have deferred care over the past several months, and it is incredibly important that they not neglect their health. Healthcare providers have implemented stringent safety precautions, and we encourage our members to seek routine and preventive care, including checkups, health screenings, and vaccinations.”

Ledoux told BusinessWest that HNE typically doesn’t know the performance of a year until probably three or four months after the year has closed.

In its planning for 2021, he explained, the company must consider uncertainties with expenses, which include utilization continuing to pre-COVID levels; increased use of high-cost technology; and costs of new pharmaceuticals, vaccines and testing, as well as increased costs for certain behavioral healthcare for children and adolescents.

Consumers are protected to an extent by state and federal laws that require health plans to rebate customers annually if the percent of premiums spent on medical expenses falls below a certain threshold.

Under the Affordable Care Act, insurers are required to use a fixed percentage of the money they take in from premiums for their customers’ medical expenses — at least 80 cents of every dollar they collect in premiums from small businesses and individuals, and 85 cents per dollar for large employers. The remaining 15% to 20% percent is what they are allowed under the ACA to spend on administrative costs like overhead and marketing, and to keep as profit. Excess revenues are to be returned to consumers in the form of rebates.

“If we perform even 0.1% better than 88%, we have to rebate that excess margin back to the market. In a regular year, our target margin is around 1.9%, which we hardly ever achieve. All these variables make it difficult to make a profit.”

Under Massachusetts’ health-insurance law, that number rises to 88 cents on the dollar. “If we perform even 0.1% better than 88%, we have to rebate that excess margin back to the market,” Ledoux said, adding that, “in a regular year, our target margin is around 1.9%, which we hardly ever achieve. All these variables make it difficult to make a profit.”

Some of those variables emerged this year in the form of concessions to the pandemic and the stress it has placed on families, he noted. “We relaxed a lot of rules on how we collect premiums. Normally it’s a 30-day grace period, and we expanded that another 30 days.” HNE also allowed furloughed employees to stay on their companies’ health plans.

“We continue to evaluate our position in the market,” he added. “There are already protections in place, profits above what would be considered reasonable, and a mandate to rebate that back to the market. We already know it self-corrects on its own.”

Meredith Wise, president of the Employers Assoc. of the NorthEast, told BusinessWest that health-insurance premiums haven’t been a big topic among EANE’s members. “We’ve heard from some employers who are getting refunds, but it hasn’t been a major thing that anyone is focusing on at the moment.”

Nationally, insurers are spending a far lower portion of premium revenue on their customers’ healthcare costs. For example, CVS said its medical-benefits ratio was 70% for the second quarter, compared to 84% over the same period in 2019.

According to a report in the New York Times, the ACA gives companies a three-year window to calculate how much to return, so members probably shouldn’t expect relief anytime soon, especially because it’s hard to tell what the rest of the year will bring, with COVID-19 numbers still fluctuating dramatically from state to state, as well as the impact of potentially expensive new vaccines or treatments around the corner. At the same time, many people who postponed getting medical attention could surge back into doctors’ offices and submit more bills for coverage.

“The second half of the year could see a lot more care, and higher costs, than the first half of 2020,” according to a statement by America’s Health Insurance Plans (AHIP). “However, if these costs never materialize and remain below certain levels, American consumers, businesses, and taxpayers are protected by provisions in federal and state laws that require health-insurance providers to deliver premium rebates and put money back into their pockets.”

Community Focus

In addition to changes in patient volume and the bottom line, the pandemic shifted the priorities of Health New England in other ways, Ledoux said.

For instance, it contributed $300,000 in grants for COVID-19 relief efforts throughout Western Mass. to help residents with access to food, mental healthcare, child care, housing, and basic needs.

The company has also made benefit adjustments that make it easier for members to get the care they need, such as eliminating out-of-pocket costs for all telehealth services and for COVID-19 diagnostic testing ordered by a medical professional, no prior authorizations for members receiving medical care for COVID-19, and flexibility with payment plans and adjusted underwriting guidelines to ease the burden for employer-group customers and members.

Meanwhile, as it approaches Medicare’s annual enrollment season, Health New England is holding online Zoom sessions and drive-up events, and has added staff to its call center, to help educate people about their Medicare options.

“The second half of the year could see a lot more care, and higher costs, than the first half of 2020.”

Tufts has implemented a number of changes as well, including compensating providers 100% of an in-office rate for telehealth, working with providers on a case-by-case basis to address their concerns regarding payment stability, extending premium payment periods for employers who need more time to make payments, and contributing $2 million to support those affected by the coronavirus outbreak in Massachusetts, Rhode Island, New Hampshire, and Connecticut.

Certainly, reports of soaring profits may persuade some lawmakers to revive proposals to cap insurers’ profits even more, but insurers say they are using their financial strength to help customers, hospitals, and doctors. In the New York Times report, AHIP also cited trends like waiving co-payments for COVID testing and treatment and paying for telemedicine visits, some of which the government has mandated be covered.

“From the very beginning,” AHIP CEO Matt Eyles said, “health-insurance providers have focused on being part of the solution.”

Joseph Bednar can be reached at [email protected]

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