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.