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Anthem takes step toward in-house PBM

Can Anthem get out of its contract with Express Scripts?

By Dan Cook | Updated on March 24, 2016
Photo: AP

These days, every major health insurer just has to have its own pharmacy unit. And those that don’t are apparently willing to go quite the length to get to that happy place. 

UnitedHealth Group has its own in-house pharmacy benefit manager, OptumRx, and ostensibly enjoys the benefits of that close relationship. Now, reports Forbes, Anthem wants one, too. The problem? It has a contract with an outside vendor, Express Scripts, through 2019. 

What to do? Dump ‘em, what else. Anthem is already in a legal dispute with Scripts, charging the vendor with price gouging. But, as Forbes notes, Anthem wants more form the federal suit than money back: It wants a divorce. 

Anthem is asking the court to allow it to terminate its Scripts contract ahead of the expiration date. Given the advantages these days of having your pharmacy management team just down the hall at one’s beck and call, three years is a long time to wait. Since its merger with Cigna gives the combined company considerable clout in prescription management, Anthem clearly wants to move quickly in that direction. 

And not a moment too soon. According to Forbes, Aetna has said it will grow a substantial in-house pharmacy unit once its merger with Humana is history. 

But can Anthem pump up Cigna’s existing, and rather small, PBM into a competitive force? First things first: Anthem needs to get out from under the Scripts contract, a move that is in no way assured at this point.

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Dan Cook

Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.

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