Tag Archives: health insurer

WellCare is Focusing on Care for Chronic Conditions

A major component of WellCare Health Plans’ (WellCare) strategy is to continually improve the quality of care and service that are provided to members. WellCare hopes to accomplish this by focusing on preventive health, wellness, and a population health management model that brings together medical, behavioral, social, and pharmacy programs to provide quality care and […]

Anthem Accelerating IngenioRx Roll-Out

Anthem, Inc. established a new pharmacy benefits manager called IngenioRx in October 2017 and entered into a five-year agreement with CVS Health’s Caremark subsidiary to begin offering PBM solutions. In January 2019, Anthem terminated the Express Scripts PBM Agreement earlier than the original expiration date of December 31, 2019 due to the recent acquisition of […]

States Begin to Take Action Against Copay Accumulator Programs

The CMS recently finalized a rule that would allow health insurers to implement copay accumulator programs to prevent drug manufacturer coupons from applying to a patient’s annual limit on out-of-pocket costs in situations where a generic drug is available. The copay “accumulator” program tracks employee use of a copay coupon and ensures the money does […]

Pharmacy Benefit Manager Market Continues to Evolve

Pharmacy Benefit Manager Market Continues to Evolve. Recent consolidation in the pharmacy benefit manager (PBM) industry has resulted in major market share divided by the three market leaders: Express Scripts, CVS Health (Caremark), and OptumRx (UnitedHealth Group). PBMs remain searching for a value proposition beyond drug distribution with their employer clients. As long as PBMs […]

Outcome-Based Contracting Acceptance Grows in Market

Specialty Pharma Services

Outcome-Based Contracting Acceptance Grows in market with the concept of taking on financial risk on complex contracts as a result of market pressure combined with more familiarity. Outcome-based contracts between pharma companies and health insurers are becoming increasingly popular. In 2016, Novartis, Amgen, and Sanofi publicized risk-sharing, value-based, outcomes-based, or pay-for-performance deals, all of which vary […]

The Anthem Cigna merger: 10 things to Know

The Anthem Cigna merger: 10 things to Know – Published July 24, 2015 By Tracey Walker, Managed Healthcare Executive Anthem’s acquisition of Cigna is being called the first “merger of titans” by industry watchers. The forces of consolidation are well under way and the merger was not totally unexpected—all of insurance is going through similar […]