Jan 31, 2019

The consolidation of health insurance and drug benefits is back

Illustration: Rebecca Zisser/Axios

Starting this spring, five corporate giants — Anthem, Cigna, CVS Health, Humana and UnitedHealth Group — will control health insurance and pharmacy benefits for more than 125 million Americans.

Why it matters: Most of this happened through rapid consolidation, and now the pressure is on these companies to prove they can better control both medical and drug spending with everything under the same roof.

Driving the news: Anthem has been working for over a year to create its own pharmacy benefit manager, called IngenioRx, so it could sever ties with Express Scripts.

  • Anthem's new prescription drug negotiator is now ready to go live by March, 10 months ahead of schedule, the company said Wednesday.

This is the new landscape. These 5 companies will handle both drug and medical bills for millions of people across Medicare, Medicaid and employer-based insurance.

  • UnitedHealth Group is the largest entity combining health insurance and pharmacy benefits, with UnitedHealthcare and OptumRx (a PBM that got significantly bigger after it absorbed Catamaran in 2015).
  • CVS acquired Aetna to pair with its existing PBM, Caremark.
  • Cigna now owns Express Scripts.
  • Anthem will be moving millions of people onto IngenioRx this year.
  • Humana also has its own PBM, and it's the fourth-largest by prescription volume.

It's worth noting that several Blue Cross Blue Shield companies also own a PBM, Prime Therapeutics.

What they're saying: PBMs "don't need to be independent entities with their own profit margins ... that adds costs," former Aetna CEO Mark Bertolini said in 2017.

  • Some research says combining health care services and prescriptions under one benefit (not necessarily one common owner) could save money, if the insurer helps people manage their diseases.
  • But insurers and PBMs have lived under the same roof before, and these companies have been doing the same work while U.S. health care spending has continued to rise.

Reality check: These companies would not have pursued merging medical and drug plan offerings if they didn't think there was a lot of money to retain.

  • Anthem's ahead-of-schedule PBM raised the company's projected 2019 adjusted earnings per share to $19 — significantly above every Wall Street estimate. Of the $4 billion in savings Anthem expects from the PBM, 20% will immediately be booked as profit.

Go deeper

Updated 12 mins ago - Politics & Policy

In photos: Protesters and police clash nationwide over George Floyd

A firework explodes behind a line of police officers next to the Colorado State Capitol during a protest over the death of George Floyd in Denver on May 30. Photo : Michael Ciaglo/Getty Images

Police used tear gas, rubber bullets and pepper spray as the protests sparked by the killing of George Floyd continued nationwide into early Sunday.

The big picture: Police responded over the weekend with force, in cities ranging from Salt Lake City to Atlanta to Des Moines, Houston to Detroit, Milwaukee to Washington, D.C., Denver and Louisville. Large crowds gathered in Minneapolis on Saturday for the fifth day in a row.

Updated 52 mins ago - Politics & Policy

George Floyd protests: What you need to know

Photo: David Dee Delgado/Getty Images

Clashes erupted between police and protesters in several major U.S. cities Saturday night as demonstrations over the death of George Floyd and other police-related killings of black men spread across the country.

The big picture: Floyd's death in Minneapolis police custody is the latest reminder of the disparities between black and white communities in the U.S. and comes as African Americans grapple with higher death rates from the coronavirus and higher unemployment from trying to stem its spread.

Massive demonstrations put police response to unrest in the spotlight

Washington State Police use tear gas to disperse a crowd in Seattle during a demonstration protesting the death of George Floyd. Photo: Jason Redmond/AFP via Getty Images

The response of some officers during demonstrations against police brutality in the U.S. has been criticized for being excessive by some officials and Black Lives Matter leaders.

Why it matters: The situation is tense across the U.S., with reports of protesters looting and burning buildings. While some police have responded with restraint and by monitoring the protests, others have used batons, tear gas, rubber bullets and other devices to disperse protesters and, in some cases, journalists.