Starting this spring, 5 corporate giants — Anthem, Cigna, CVS Health, Humana and UnitedHealth Group — will control both health insurance and pharmacy benefits for more than 125 million Americans.
Why it matters: Most of this happened through rapid consolidation. Now the pressure is on these companies to prove that putting everything under the same roof will help them better control both drug and medical spending, my colleague Bob Herman writes.
Driving the news: Anthem said yesterday that its new PBM, which it has been working on for over a year, will be ready to go in March — 10 months earlier than expected.
This is the new landscape.
- 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 its new PBM, IngenioRx, this year.
- Humana also has its own PBM, and it's the fourth-largest by prescription volume.
- Outside those big 5, it's worth noting that Blue Cross Blue Shield plans also own a PBM — Prime Therapeutics.
What's old is new again. Insurers and PBMs have lived under the same roof before, but separated years ago. Now they're coming back together.
- 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.
The bottom line: 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.