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 […]
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 […]
Diplomat has realized it needs to accelerate the implementation of its new payer sales strategy for CastiaRx
Walmart and Home Depot, two of the top 10 U.S. employers, are using copay accumulator programs
Centene is leveraging its investment in RxAdvance to develop a more transparent PBM through Envolve Pharmacy Solutions
Express Scripts Divesting United Biosource. Express Scripts and Avista Capital Partners, a leading private equity firm, recently announced that Avista has signed a definitive agreement to acquire United BioSource (UBC), a wholly-owned subsidiary of Express Scripts Holding Company. Founded in 2003 and headquartered in Blue Bell, Pennsylvania, UBC is a leading provider of pharmaceutical and patient […]
Care outside the hospital, like P&T committee responsibilities outside the hospital, is necessarily different. New processes and solutions, such as cloud computing, can help improve performance and transparency of benefit management for purchasers or users of health care services. The current role of PBMs includes concurrent improvement in health outcomes, so the take-home message is […]
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 […]