Health plans getting into the PBM game

Bloomberg reports that Anthem is creating is own pharmacy benefits manager (PBM).  Why?  It says it wasn’t getting a good deal from PBMs.

Health insurer Anthem Inc. plans to set up its own pharmacy benefits management unit, signaling a final break with Express Scripts Holding Co. after accusing it of overcharging by billions of dollars.

The move means Express Scripts will not only lose its biggest client but also face a new rival. Anthem’s new unit, called IngenioRx, will grow its own business with a “full suite” of services, the insurer said in a statement on Wednesday.

How much was the overcharging?  Anthem says the amount was $3 billion.

With drug prices on the rise, both pharma and PBM’s blame each other for high prices.  PBMs say that drug list prices are too high.  Pharmacetuical firms say they need to raise prices in order to offset large discounts and rebates that PBMs are demanding.

Anthem may not be the only firm entering the PBM market.  Amazon is also considering entering the PBM market.  UnitedHealth–Anthem’s top competitor–already has an in-house PBM known as OptumRx.

The one thing that is certain in the PBM world is that things are changing.

 

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