Humana/Anthem PBM Venture Could Attract More Blues Plans

by Jane Anderson

 

THumana Inc. and Anthem, Inc. are teaming up with hedge fund administrator SS&C Technologies Holdings, Inc. to create DomaniRx, a new joint venture that aims to offer a "best-in-class" PBM cloud-based claims adjudication platform.

Background:

• Humana will be the first customer for DomaniRx, which will leverage SS&C's technology capabilities and will reside on SS&C's private cloud, according to the company.
• SS&C, which holds an 80.2% interest in DomaniRx, plus the two insurers have invested $925 million in the joint venture, according to a document filed with the Securities and Exchange Commission.

'Leading with tech':

• Ashraf Shehata, national sector leader for health care and life sciences at KPMG, says the partnership between SS&C, Anthem and Humana is "a pretty bold move that I call 'leading with tech,'" which ultimately could result in potent new patient-facing and pharmacy tools to manage drug benefits.
• "Scale and capability are the name of the game when it comes to PBMs," says Peter Manoogian, principal at ZS Associates. "Both of these entities [Humana and Anthem] are looking to grow across segments….To compete with the big three [PBMs], I suspect both orgs looked at each other and said, 'We are better off doing this JV to accelerate to scale and capability, versus going it alone, thus helping both firms compete against the big three and win market share.'"
• However, Elan Rubinstein, Pharm.D., head of pharmacy benefits consulting firm EB Rubinstein Associates, notes that the joint venture announcement doesn't offer any information about how DomaniRx will be better or unique when compared to other offerings in the market.

MA could be a focus:

• Initially, DomaniRx's success will depend on how many covered lives are converted from Anthem and Humana, Shehata says.
• Next, he says, "I think the question is, are there going to be offerings that will be appealing to a Blues plan, because there are a lot of Blues plans that like to work with a Blue owner, and clearly that could be something attractive if Anthem's in. I'd say the other thing that we're probably going to see, since Humana's involved in it, is there's going to be very much a clear affinity towards Medicare Advantage product design."

From RADAR on Drug Benefits