Industry analyzes WellPoint PBM buy

May 1, 2009

United says it has no plans to follow suit by selling off its pharmacy benefit services. WellPoint will oursource now.

"This is one strategy to gain access to a large number of members within Blue plans," says Mary Ann McCauley, a healthcare marketing and communication consultant. "The two organizations' business models that focus on mail service and extensive use of generics are compatible, making the transition for members potentially less stressful."

Some industry watchers are wondering whether or not UnitedHealth Group intends to put its PBM, Prescription Solutions, on the block.

While it relies on an outside company, Medco Health Solutions, to provide drug benefits for its commercial insurance customers, it has its own pharmacy benefits management company for many of its Medicare beneficiaries.

A company statement reiterated that UnitedHealth would continue to invest in Prescription Solutions, its in-house PBM, "to fully realize its strong growth potential in serving both internal and external customers."

WELLPOINT TO CONTRACT SERVICE

WellPoint spokesperson Cheryl Leamon tells MANAGED HEALTHCARE EXECUTIVE that WellPoint considered several options and determined that it could provide the most value to members and shareholders by selling its PBM entities, and then contracting with a leading PBM that is entirely focused on delivering pharmaceutical solutions to provide all pharmacy services.

According to Leamon, selling WellPoint's NextRx subsidiaries will "enhance our health plan service offerings, keep costs down for members and customers and improve the quality of the healthcare delivered, for both the medical services and drugs that our members may need."

WellPoint will retain control of the formulary as well as its data analytics and integrated disease management and clinical pharmacy programs.

"As we evaluated the future outlook for the NextRx businesses, we found that in order to further improve performance and truly achieve best-in-class pharmaceutical management for our members, significant enhancements and investments would have been necessary," says Leamon.

For example, mail-order utilization at NextRx was about 10% in 2008, which compares with the 24% achieved by Express Scripts last year. NextRx also has fewer economies of scale than the sector's larger companies.