Pharmaceutical Services as an Asset Class: Assetization of Pharmaceutical Care and Lifestyle Products in Primary Care

Prologue: On the website of the online pharmacy there is a six-minute podcast. A woman and a man chat about the use of medication for weight loss. In addition to Ozempic, they discuss other medicines that can be ordered via the website. They tell each other that a prescription for these medicines can be obtained through a general practitioner, but also via an(online) doctor. The pros and cons of the medication are discussed. A healthy lifestyle is crucial, but they conclude that this medication can be a good support. Main text: Internet pharmacies are a rapidly emerging type of healthcare provider where patients can quickly obtain (lifestyle) medication. This includes medication that is reimbursed and medication that patients must pay for out of pocket, such as Ozempic. Pharmacy is a striking example of the assetization trend in healthcare – the process in which ‘things’ are turned into assets to generate an income revenue and that transform healthcare into saleable and tradeable assets for global investors (Birch and Muniesa, 2020. Other examples are private equity investors that acquire hospitals or elderly care facilities (Batt and Appelbaum 2023, De Brabandere et al. 2024). This focus on corporate interventions and financial strategies works in concert with the imperative to maximize shareholder value and has been reinforced by neoliberal ideologies emphasizing market-oriented thinking, the privatization of public services, and dismantling of welfare states. This paper takes the assetization of pharmaceutical services as a case to examine how the acquisition of pharmacists by private equity and venture capital impacts the institutional fabric of healthcare systems. We build on sociological and political economy literatures on assetization and financialization to study, first, how pharmacists –both online pharmacies and traditional pharmacies in primary care– have been targeted by financial actors, and second, how value is being created through new relationships between finance, technology, medicine, and care. We build on qualitative research in the Netherlands, in which we (1) map the corporate interventions in pharmacies and pharmaceutical services to trace the role of investors and their investments (e.g., purchase value, total investment, ownership, relationship with public governance arrangements), and (2) conduct critical discourse analysis to analyse communication with state actors, regulators, professionals and users, including policy and annual reports, press releases and online communication through websites, apps, and social media. The research shows that acquisitions and for-profit service provision are not just economic or financial but very much infrastructural in nature. This includes the introduction of (international) corporate actors in Dutch healthcare, industry integration (preferred providers, revenue sharing), the provision of integrated services and technological transition, like online consultation and exchange of data and device identifiers to trace consumers to offer targeted products. The research reveals how the assetization of pharmaceutical care contributes to a new political economy of care, reconfiguring traditional care by shifting the focus to targeted, and thus fragmented, services for specific patient groups as consumers, as well as to (new groups of) healthcare professionals who integrate corporate goals into their clinical and caring work.