Health insurer Anthem has announced that it will launch its own pharmacy benefit management (PBM) company, IngenioRx, that will operate in partnership with CVS Health, in 2020.
Health insurer Anthem has announced that it will launch its own pharmacy benefit management (PBM) company, IngenioRx, that will operate in partnership with CVS Health, in 2020.
The health insurer has signed a 5-year agreement (commencing in January 2020) to partner with CVS Health, which operates its own PBM under the name Caremark. CVS Health will contribute its experience with point-of-sale engagement, member messaging, and Minute Clinic programs along with prescription fulfillment and claims processing. The new PBM will serve customers whose health plans are affiliated with Anthem, as well as non-Anthem customers.
“During the past two years, we have been very clear that we can strengthen the value offered to the marketplace with an improved and aligned PBM model,” said Joseph R Swedish, chairman, president, and CEO of Anthem, in a statement. “Through the process of evaluating many PBM options in preparation for the expiration of our current contract, we determined that our scale and experience best position us to deliver an innovative solution, and the launch of IngenioRx will allow us to break through what is now a complex and fragmented landscape.”
News of IngenioRx’s development comes as Anthem’s current contract with Express Scripts nears its 2019 expiry. Express Scripts and the insurer have been engaged in a high-profile dispute over PBM services for some time. In 2016, Anthem sued Express Scripts for $15 billion and the option to terminate its contract over claims that Express Scripts had failed to pass along savings from drug-pricing negotiations. According to the PBM’s financial data, Express Scripts netted $17.1 billion in revenue from Anthem in 2016.
With the launch of IngenioRx, Anthem will gain control over its clinical and formulary decisions, and will negotiate its own rebates with drug manufacturers. That scenario has the potential to provide greater transparency concerning the costs of prescription drugs to both Anthem-run health plans and to employers.
Greater insight into the costs of drugs would be welcome news to many stakeholder groups; Angus Worthing, MD, a practicing rheumatologist and chair of the American College of Rheumatology’s Government Affairs Committee, recently wrote in an opinion piece in The Center for Biosimilars® that a lack of transparency surrounding PBMs’ rebate negotiations can hamper competition, especially with respect to biosimilars and biologics: “PBMs pressure drug makers to grant them high rebates in exchange for a favorable position on their list of approved drugs. This rebate system is destructive to the biosimilars market, hinders patient care, and costs consumers billions,” Worthing said. “The medical community must come together to demand greater transparency in drug pricing, starting with PBMs.”
PBMs have also come under fire for the practice of administering direct and indirect remuneration (DIR) fees, which some claim could drive up drug prices for Medicare Part D beneficiaries and taxpayers. A whitepaper produced by the law firm Frier Levitt, LLC for the Community Oncology Alliance (COA) claimed that, while DIR fees began as a strategy to encourage drug price transparency, “DIR fees have been twisted by PBMs into an abusive and overly-broad ‘backdoor’ vehicle for clawing back additional monies and increasing their own profits.”
Eye on Pharma: Bevacizumab Update; Samsung Bioepis, J&J Settlement; Another EU Trastuzumab
December 6th 2023Outlook Therapeutics provides an update on the development of its bevacizumab candidate for age-related macular degeneration; Samsung Bioepis settles with Johnson & Johnson (J&J) over its ustekinumab biosimilar candidate; and the European Union gains another trastuzumab biosimilar.
Biosimilar Business Roundup for October 2023—Podcast Edition
November 5th 2023On this episode, we discuss the biggest news to come out of October 2023, including 3 regulatory approvals, 2 complete response letters, and new data and industry insights that have the potential to impact the entire US biosimilar industry.
CVS Caremark Switches Up Biosimilar Coverage in 2024
November 27th 2023As new biosimilars are added to CVS Caremark’s standard formulary, others are removed. One notable change is with the Humira biosimilars: the pharmacy benefit manager has removed Amjevita in favor of Hyrimoz and an unbranded biosimilar.
Biosimilars Business Roundup For August 2023—Podcast Edition
September 5th 2023On this episode, we’re giving an overview of some of the biggest stories in the business space regarding biosimilars, like the approval of the first neurology biosimilar, growth projections from company quarterly expense reports, and some analyses about the health of the market.
AMCP Nexus: Panelists Share Current Scope of Biosimilar Industry
October 26th 2023Panelists at the Academy of Managed Care Pharmacy (AMCP) Nexus meeting chronicled the current state of the US biosimilar market, including current policies impacting the market, recent regulatory decisions, and the developing arguments around requirements for clinical efficacy studies.