What Anthem's new PBM, IngenioRx means for Brokers and Employers

What Anthem's new PBM, IngenioRx means for Brokers and Employers

Anthem, Inc. recently announced that it is establishing a new pharmacy benefits manager (PBM) named IngenioRx. Starting January 1, 2020, IngenioRx will begin offering a full suite of PBM solutions to customers of Anthem’s health plans, as well as non-Anthem customers.

Anthem will enter into a five-year agreement with CVS Health to support this initiative. CVS Health will provide the back-end prescription fulfillment and claims processing services. In addition, IngenioRx will utilize CVS Pharmacy and MinuteClinic for member messaging and engagement at the point-of-sale to drive better health care outcomes.

Members serviced through Anthem by Express Scripts today will continue to use their benefits the same as they do currently, with a forthcoming transition plan for migrating members to IngenioRx. The assumption is that the aligned model of integrated medical and Rx benefit data could lead to more value-based contracting for integrated Anthem/IngenioRx plans.

At this time, it’s too early to tell how IngenioRx and CVS Health will compete in the carve-out PBM marketplace, particularly for plans with Anthem as a medical provider, and it is still unknown how Anthem's expected cost savings will translate to lower costs for employer groups.

This news is not a complete surprise as last April, Anthem’s current PBM provider, Express Scripts, announced that Anthem had chosen to not renew its contract which expires in 2019.  Express Scripts entered into a 10-year contract in 2009 when Express Scripts acquired Anthem's in-house PBM, NextRx, for $4.675 billion.  Anthem was responsible for roughly 18% of Express Scripts' first quarter 2017 revenue.

Truveris will look to Anthem, CVS Health and IngenioRx to define the rules-of-engagement for existing and potential clients evaluating PBM partners in the future.

Key Takeaways
  • Anthem's relationship with Express Scripts is scheduled to expire at the end of 2019
  • The details of the transition to IngenioRx for Anthem’s current members to be announced through a forthcoming transition plan to minimize member disruption
  • It's too early to tell how exactly IngenioRx and CVS Health's PBM (CVS Caremark) will compete against each other in the carve-out PBM marketplace, but Anthem/IngenioRx plan on taking its new integrated model national
  • Anthem will maintain its own formulary, and not take on CVS (Caremark's) approved drug list



Topics: Trends, Insights & Analysis, Enterprise Employers, Labor Unions, State & Public Employers, Brokers, Pharmacy Benefit Managers

Posted by

Truveris Team