UnitedHealth, Cigna, CVS Tout Strong Selling Seasons for PBMs Segments

by Leslie Small

 

During their recent fourth-quarter and full-year 2022 earnings calls, the companies that own the country’s largest PBMs all said they expect that part of their business to gain momentum this year thanks to successful selling seasons in which their increasingly diversified offerings resonated with clients.     PBM businesses are growing   In 2022, “Optum Rx revenues grew 9%, approaching $100 billion for the year, driven by continued strong sales and the expansion of our pharmacy services businesses,” UnitedHealth Group Executive Vice President and Chief Financial Officer John Rex said during the company’s Jan. 13 conference call to discuss financial results. “Both customer retention and new customer wins were among the highest Optum Rx has ever delivered, laying a strong foundation for continued market-leading growth,” he added.   CVS Health Corp., which owns the PBM Caremark, expects revenue from its pharmacy services segment to grow between 1% and 2% this year, “driven by a successful 2023 selling season and strong retention, partially offset by lower Medicaid volume,” Chief Financial Officer Shawn Guertin said during the company’s Feb. 8 earnings call.    And during The Cigna Group’s Feb. 3 earnings call, Chief Financial Officer Brian Evanko said 2022 “marked another year of sustained growth and profitability in Evernorth as our innovation, market-leading clinical capabilities, and proven track record of delivering for clients and customers continued to resonate in the market.” Evernorth is the company’s health services segment, housing the PBM Express Scripts.  Express Scripts’ biggest business win continues to be its contract to provide PBM services to Centene. Cigna’s gain was CVS Health’s loss, as Caremark had been providing PBM services to Centene.   Execs stress flexible biosimilar strategies  Another hot topic for executives at diversified, publicly traded managed care companies was the first Humira biosimilar to reach the U.S. market — Amgen, Inc.’s Amjevita. UnitedHealth recently told AIS Health that it will cover Amjevita “at parity” with its reference product and let its commercial clients choose between the biosimilar’s two list prices, while Cigna said late last year that “it will add biosimilars as preferred products on its commercial formularies at the same position as Humira.”   CVS Health, meanwhile, said that while it will cover the new-to-market biosimilar, “Humira will remain the preferred specialty product and Amjevita will be a non-preferred specialty product.”   Speaking during Cigna’s Feb. 3 earnings call, Cordani explained that “the co-preferred position [for Amjevita] that we have taken on our National Preferred Formulary is a mechanism to aid the transition [and] preserve and expand choice" for clients.   At UnitedHealth, “the work that's been done within Optum Rx to deliver a contracting strategy which ensures that everybody who wants to use a Humira molecule — whether that’s the brand or whether it’s a biosimilar — gets access to lower cost right out of the gate, has been a super important innovation,” Witty said. And during CVS Health’s earnings call, Lynch said in her prepared remarks that “our approach to biosimilars reflects our commitment to drive the lowest net cost for our clients while providing members coverage of clinically safe, effective medications and ensuring continuity of care.”

 

From Radar on Drug Benefits

 

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