6 Takeaways from 2021 PBMI Annual National Conference

The three-day 2021 Annual National Conference of the Pharmacy Benefit Management Institute® last week featured more than a dozen speakers discussing everything from interoperability to digital therapeutics to preparations for switching PBMs to the COVID-19 pandemic. Here are six takeaways from the meeting.

Anthem, Humana Drop Nearly $140M to Launch New PBM

Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, as criticism over traditional PBMs’ operations kickstarts business at startups that promise transparency. The insurers will hold a minority stake in the new joint venture, named DomaniRx, which is being championed by SS&C Technologies. The Windsor, Conn.-based fintech company owns approximately 80% of the new business, according to a filing submitted to the U.S. Securities and Exchange Commission on July 15.

Navitus Health Solutions Continues Growth with Acquisitions of EpiphanyRx and Quality Drug Clinical Care

Navitus Health Solutions, a full pass-through pharmacy benefit manager (PBM), today announced that it has acquired EpiphanyRx, a next-generation PBM solution headquartered in Brentwood, TN, strengthening Navitus’ ability to serve the unique needs of employers. Lumicera Health Services, Navitus’ wholly-owned specialty pharmacy, has also purchased Quality Drug Clinical Care, a specialty pharmacy serving patients with HIV in Irvine, CA, to better serve patients located in the western United States.

EmpiRx Health Announces Strategic Growth Investment from Nautic Partners

EmpiRx Health (“EmpiRx”), the industry’s only value-based pharmacy benefit manager, is pleased to announce a strategic growth investment from Nautic Partners (“Nautic”). The new partnership will further EmpiRx’s investment in tech-enabled clinical innovation and care models, while expanding its reach in the market to those who need differentiated pharmacy solutions that drive improved patient quality and access, while lowering the total cost of healthcare.

FTC Antitrust Investigations Eye Hospitals, PBMs and Drug Companies

The Federal Trade Commission is focusing its antitrust sights on the healthcare industry, primarily hospitals, drug companies and pharmacy benefit managers. The agency on Thursday voted to prioritize investigations into healthcare, tech and digital platforms over the next decade and authorized the use of subpoenas and other “compulsory” methods to obtain information. No further details were announced about specific companies it would investigate.

States Probe Business Practices of Pharmacy Benefit Managers

Several states are investigating pharmacy benefit managers, with some saying they are focused on whether the companies fully disclosed details about their business and potentially received overpayments under state contracts, according to state officials and documents. States including Ohio, Oklahoma, Georgia, New Mexico, Kansas, Arkansas and Mississippi, as well as the District of Columbia, are scrutinizing PBMs, according to the offices of state attorneys general and auditors, as well as public documents including state contracts and securities filings.

Centene’s $2.2B Planned Buyout Approved by Magellan Shareholders

Clayton-based Centene Corp.’s planned $2.2 billion buyout of Magellan Health Inc. was approved last week by Magellan’s shareholders. Centene (NYSE: CNC), a provider of managed health care services, agreed in January to acquire Phoenix-based Magellan Health for $95 per share in cash, a 14.7% premium to Magellan’s last closing price before the deal. Earlier, Centene said the deal had cleared U.S. antitrust approval. The acquisition is still expected to close in the second half of the year, subject to state regulatory approvals and customary closing conditions.

With Telehealth, Pharmacy Offerings, Amazon Starts to Encroach on PBMs

As Amazon starts to roll out its telehealth and pharmacy offerings, most big health systems and insurers don’t yet view it as a threat. But pharmacy benefit managers and vertically integrated payers will be keeping a watchful eye on the company as it starts to encroach on a slice of their business.

Centene Announces Expiration of Hart-Scott-Rodino Waiting Period with Respect to the Company’s Proposed Acquisition of Magellan Health Inc.

Centene Corporation (NYSE: CNC) has announced that as of 11:59 p.m. on March 12th, 2021, the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 with respect to the Company’s proposed acquisition of Magellan Health Inc. has expired. As previously announced on January 4, 2021, the transaction will broaden and deepen Centene’s whole health capabilities and establish a leading behavioral health platform. The combined platform lays the foundation by which the company will continue to invest and innovate for its members, enabling improved health outcomes and faster, diversified growth.

PE-Backed Advanced Medical Pricing Solutions (AMPS) Expands Healthcare Cost Management Suite with Acquisition of Drexi

Advanced Medical Pricing Solutions (AMPS), a pioneer in healthcare cost management, is pleased to announce it has acquired Drexi, a pharmacy solution that enables savings by transparent pricing and pass-thru on prescription medications available at a nationwide network of more than 65,000 pharmacies. “This acquisition is part of AMPS’ strategic vision and growth plan to provide a spectrum of programs to manage healthcare costs,” said Kirk Fallbacher, AMPS president and CEO. “With the addition of Drexi, AMPS can now drive savings on more than 90 percent of the benefit expense associated with a self-funded group.”