Alia
Paavola – April 10, 2019
Pharmacy benefit managers stepped in to help
manage prescription claims for insurers when coverage expanded under the ACA
and with the creation of the Medicare Part D program.
But today, they handle way more than claims processing,
according to Agent Survival Guide. They help with
formulary management, drug utilization review, determining which pharmacies are
in-network and how much those pharmacies will receive in reimbursement.
Their expanded role in the drug supply chain
has made them valuable partners for top insurers.
Below are the five top insurers and their
pharmacy benefit management partners:
1. UnitedHealth Group. UnitedHealth created OptumRx, its in-house PBM by combining
existing pharmacy and care delivery services within the company in 2011. It
also purchased CatamaranRx in 2015, which expanded its PBM capabilities.
2. Anthem. Anthem
will launch an in-house PBM called IngenioRx. Initially expected to launch in
2020, the insurer said it will now expedite the roll out. In March, Anthem
terminated its PBM agreement with Express Scripts.
3. Aetna. Aetna
recently merged with CVS Health. As a result, Aetna now has access to CVS
Caremark, the PBM of CVS Health.
4. Cigna. Cigna recently merged with Express Scripts, one
of the top PBMs in the nation. It also had Cigna Pharmacy Management, a smaller
in-house PBM.
5. Humana. Humana
has its own in-house PBM called Humana Pharmacy Solutions.
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