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
Sources

http://ir.antheminc.com/phoenix.zhtml?c=130104&p=irol-newsArticle&ID=2309388
https://www.prnewswire.com/news-releases/cvs-health-signs-five-year-agreement-with-anthem-inc-to-provide-services-to-support-ingeniorx-300538665.html
http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-newsArticle&ID=2264113
http://www.businessinsider.com/anthem-creates-pharmacy-benefit-manager-ingeniorx-2017-10 
http://markets.on.nytimes.com/research/stocks/news/press_release.asp?docTag=201710180600BIZWIRE_USPRX____BW5618&feedID=600&press_symbol=286158 

 

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

Posted by

Truveris Team